美国田纳西州范德比尔特大学医学中心Tina V Hartert团队研究了美国婴儿呼吸道合胞病毒感染和儿童哮喘发病率的相关性。2023年4月19日出版的《柳叶刀》杂志发表了这项成果。

早期严重呼吸道合胞病毒（RSV）感染与儿童哮喘的发病有关。然而，婴儿期呼吸道合胞病毒感染与儿童哮喘发展之间的关系尚不清楚。该研究旨在评估婴儿期呼吸道合胞病毒感染与儿童哮喘之间的关系。

INSPIRE是一个基于人群的大型出生队列，由2012年6月至12月或2013年6月和12月足月出生的非低出生体重健康婴儿组成。从美国田纳西州中部的11家儿科诊所招募婴儿。研究组通过分子和血清学技术，将被动和主动监测与病毒识别相结合，确定了出生第一年的呼吸道合胞病毒感染状况（无感染与感染）。之后对儿童进行前瞻性随访，以了解5年期哮喘的主要结局，研究组对所有完成5年随访的参与者进行了分析。根据儿童的性别、种族和民族、任何母乳喂养、婴儿期日托、子宫内或婴儿早期接触二手烟以及母亲哮喘，对有可用数据的儿童进行的统计模型进行了校正。

在参与这项研究的1946名符合条件的儿童中，1741名（89%）有可用数据来评估出生第一年的呼吸道合胞病毒感染状况。在1741名儿童中，婴儿期呼吸道合胞病毒感染的儿童比例为944人（54%）。在婴儿期未感染呼吸道合胞病毒的儿童中，患有5年期哮喘的儿童比例（587人中的91人[16%]）低于婴儿期感染呼吸道合病毒的儿童（670人中的139人[21%]；p=0.016）。与婴儿期感染呼吸道合胞病毒相比，婴儿期未感染呼吸道合病毒与5年期哮喘风险降低26%有关（校正后的RR为0.74）。可通过避免婴儿期呼吸道合胞病毒感染来预防的5年期哮喘病例的估计比例为15%。

研究结果表明，在足月出生的健康婴儿中，在出生的第一年没有感染呼吸道合胞病毒与患儿童哮喘的风险显著降低有关。婴儿期呼吸道合胞病毒感染与儿童哮喘之间存在年龄依赖性关联。然而，为了确定因果关系，需要研究预防、延迟或降低儿童哮喘初始呼吸道合胞病毒感染严重程度的干预措施的效果。

附：英文原文

Title: Respiratory syncytial virus infection during infancy and asthma during childhood in the USA (INSPIRE): a population-based, prospective birth cohort study

Author: Christian Rosas-Salazar, Tatiana Chirkova, Tebeb Gebretsadik, James D Chappell, R Stokes Peebles, William D Dupont, Samadhan J Jadhao, Peter J Gergen, Larry J Anderson, Tina V Hartert

Issue&Volume: 2023-04-19

Abstract:

Background

Early-life severe respiratory syncytial virus (RSV) infection has been associated with the onset of childhood wheezing illnesses. However, the relationship between RSV infection during infancy and the development of childhood asthma is unclear. We aimed to assess the association between RSV infection during infancy and childhood asthma.

Methods

INSPIRE is a large, population-based, birth cohort of healthy infants with non-low birthweight born at term between June and December, 2012, or between June and December, 2013. Infants were recruited from 11 paediatric practices across middle Tennessee, USA. We ascertained RSV infection status (no infection vs infection) in the first year of life using a combination of passive and active surveillance with viral identification through molecular and serological techniques. Children were then followed up prospectively for the primary outcome of 5-year current asthma, which we analysed in all participants who completed 5-year follow-up. Statistical models, which were done for children with available data, were adjusted for child's sex, race and ethnicity, any breastfeeding, day-care attendance during infancy, exposure to second-hand smoke in utero or during early infancy, and maternal asthma.

Findings

Of 1946 eligible children who were enrolled in the study, 1741 (89%) had available data to assess RSV infection status in the first year of life. The proportion of children with RSV infection during infancy was 944 (54%; 95% CI 52–57) of 1741 children. The proportion of children with 5-year current asthma was lower among those without RSV infection during infancy (91 [16%] of 587) than those with RSV infection during infancy (139 [21%] of 670; p=0·016). Not being infected with RSV during infancy was associated with a 26% lower risk of 5-year current asthma than being infected with RSV during infancy (adjusted RR 0·74, 95% CI 0·58–0·94, p=0·014). The estimated proportion of 5-year current asthma cases that could be prevented by avoiding RSV infection during infancy was 15% (95% CI 2·2–26·8).

Interpretation

Among healthy children born at term, not being infected with RSV in the first year of life was associated with a substantially reduced risk of developing childhood asthma. Our findings show an age-dependent association between RSV infection during infancy and childhood asthma. However, to definitively establish causality, the effect of interventions that prevent, delay, or decrease the severity of the initial RSV infection on childhood asthma will need to be studied.

DOI: 10.1016/S0140-6736(23)00811-5

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(23)00811-5/fulltext