哮喘高危婴幼儿喘息发作期病毒病原及过敏原检测分析

Detection of viral pathogens and allergens in infants and young children at high risk of asthma during a wheezing episode

摘要:

目的分析哮喘高危婴幼儿喘息发作期病毒病原学、过敏原分布，为喘息患儿的早期诊断与干预治疗提供帮助。方法选取2016年4月至2017年8月因喘息性支气管炎和喘息性支气管肺炎住院的135例哮喘高危婴幼儿为研究对象。采用荧光探针PCR法检测患儿鼻咽部抽吸物标本甲型流感病毒（Flu-A）、呼吸道合胞病毒（RSV）、腺病毒（ADV）、副流感病毒（PinF）、人鼻病毒（HRV）、人偏肺病毒（hMPV）、博卡病毒（HBoV）感染情况；采用ImmunoCAP技术检测患儿吸入性变应原、食物性变应原及总IgE浓度。结果 135例患儿中，鼻咽部抽吸物标本病毒检出阳性率为49.6%，各病毒检出阳性率由高到低依次为HRV 25.2%、HBoV 9.6%、RSV 8.1%、PinF 5.9%、Flu-A 3.7%、ADV 1.5%、hMPV 0.7%。HRV在1~3岁年龄组检出率高于<1岁组（P < 0.05）。过敏原筛查试验阳性率为59.3%，吸入性过敏原阳性率为44%，食物性过敏原阳性率为89%；吸入性过敏原中阳性率由高到低依次为尘螨77%、霉菌37%、花粉26%、动物皮屑9%；食物性过敏原中阳性率由高到低依次为鸡蛋白73%、牛奶68%。<1岁组吸入性过敏原阳性率大于1~3岁组（P < 0.05）；1~3岁组T-IgE水平明显高于<1岁组（P < 0.05）。病毒检出组吸入性过敏原阳性率大于病毒未检出组（P < 0.05）。第2次喘息患儿吸入性、食物性过敏原阳性率及T-IgE水平均高于第1次喘息患儿（P < 0.05）；吸入性过敏原尘螨、霉菌在第2次喘息患儿中阳性率高于第1次喘息患儿（P < 0.05）。结论早期HRV感染和吸入性过敏原阳性与哮喘高危婴幼儿喘息发生密切相关。

Abstract:

Objective To investigate the viral etiology and allergen distribution in infants and young children at high risk of asthma during a wheezing episode. Methods A total of 135 infants and young children at high risk of asthma were enrolled who were admitted due to asthmatic bronchitis or asthmatic bronchopneumonia between April 2016 and August 2017. Fluorescent probe PCR was used to measure influenza A (Flu A), respiratory syncytium virus (RSV), adenovirus (ADV), parainfluenza virus (PinF), human rhinovirus (HRV), human partial lung virus (hMPV) and human bocavirus (HBoV) in nasopharyngeal aspirates. ImmunoCAP was used to measure inhaled allergens, food allergens, and total IgE concentration. Results Among the 135 patients, the overall virus detection rate of nasopharyngeal aspirates was 49.6%, and HRV had the highest detection rate of 25.2%, followed by HBoV (9.6%), RSV (8.1%), PinF (5.9%), Flu-A (3.7%), ADV (1.5%) and hMPV (0.7%). The 1-3 years group had a significantly higher detection rate of HRV than the <1 year group (P < 0.05). The positive rate of allergen screening was 59.3%, with 44% for inhaled allergens and 89% for food allergens. Among the inhaled allergens, dust mites had the highest positive rate of 77%, followed by mould (37%), pollen (26%) and animal dander (9%). Among the food allergens, egg white had a positive rate of 73% and milk had a positive rate of 68%. The <1 year group had a significantly higher positive rate of inhaled allergens than the 1-3 years group (P < 0.05). The 1-3 years age group had a significantly higher level of T-IgE than the <1 year group (P < 0.05). The positive virus group had a significantly higher positive rate of inhaled allergens than the non-virus group (P < 0.05). The children with the second wheezing episode had significantly higher positive rates of inhaled allergens and food allergens and level of T-IgE than those with the first wheezing episode (P < 0.05). The children with the second wheezing episode also had significantly higher positive rates of dust mites and mould than those with the first wheezing episode (P < 0.05). Conclusions Early HRV infection and inhaled allergen sensitization are closely associated with the development of wheezing in infants and young children at high risk of asthma.