在早產併有支氣管肺發育不全的族群給予呼吸道融合病毒免疫預防與日後氣喘症狀發展的關係

Abstract

<背景> 在台灣，呼吸道融合病毒是常見的終年呼吸道感染的原因。嬰幼兒得到呼吸道融合病毒感染造成細支氣管炎住院之後，日後容易引起喘鳴或氣喘的問題。早產和肺支氣管擴張不全都是會造成嚴重呼吸道融合病毒感染住院的危險因子。施打palivizumab已被報導能預防嚴重的呼吸道融合病毒感染住院率，尤其是早產或有併發肺支氣管擴張不全的族群身上。 <研究目標> 我們想要探討施打palivizumab這個呼吸道融合病毒的疫苗，在早產併有肺支氣管擴張不全的台灣兒童身上，日後發展出氣喘症狀的風險。 <方法> 研究納入的受試者，是從1999年1月到2015年12月，在台灣的馬偕紀念醫院出生，是早產又併有肺支氣管擴張不全的兒童。所有受試者的醫療紀錄被回溯蒐集並加以分析，資料蒐集時間至孩童成長為5歲或20歲不等。研究評估肺支氣管擴張不全的早產兒，施打palivizumab之後，發展出氣喘和氣喘症狀表現的風險。 <結果> 收案總計有616個孩童，其中有576個受試者符合納入條件，並加以分析醫療紀錄。306 (53.2%)個孩童有接受過palivizumab的施打，191 (33.2%)個孩童日後被診斷為氣喘。曾經因為呼吸道融合病毒感染導致細支氣管炎住院的孩童，有比較高的風險日後發展出氣喘[odds ratio (OR)=3.77 (2.30-6.20), p value < 0.001; hazard ratio (HR)=2.56 (1.81-3.62), p value < 0.001]。施打Palivizumab之後，可以透過減少呼吸道融合病毒細支氣管炎的住院率，進而達到減少日後發展出氣喘症狀的效果(p value=0.027)。有施打palivizumab的氣喘孩童，比起沒施打疫苗的人來說，會有比較短的氣喘症狀活躍天數。 <結論> 早產併有肺支氣管發育不全的孩童，若曾經因為呼吸道融合病毒感染造成細支氣管炎住院，會有比較高的風險日後有氣喘的表現。預防性地給予palivizumab，可以透過減少呼吸道融合病毒細支氣管炎的感染，進而減少日後氣喘的發展。而在那些已經發展出氣喘的孩童身上，palivizumab可以減少氣喘症狀活躍的天數。

<Background> In Taiwan, respiratory syncytial virus (RSV) is a common cause of respiratory tract infections year-round. Infants with RSV bronchiolitis hospitalization are more likely to have wheezing and subsequent asthma. Prematurity and Bronchopulmonary dysplasia (BPD) are important risk factors for severe RSV hospitalization. Passive immunization with palivizumab has been reported to be effective in preventing RSV hospitalization in children at greater risk, such as prematurity and BPD. <Study objective> We want to explore the effect of RSV immunoprophylaxis in the risk of asthma symptoms development in prematurity with BPD of Taiwanese. <Method> Children born as preterm with BPD in Mackay Memorial Hospital, Taipei, Taiwan, from January 1999 to December 2015 were enrolled. All subjects’ medical records were retrospectively collected up to 5 to 20 years of age. We evaluate the risk of active asthma onset and asthma presentation after palivizumab exposure in BPD populations. <Result> Total 576 consecutive cases were recruited into this study and reviewed their medical records. 306 (53.2%) patients ever had palivizumab injections and 191 (33.2%) subjects were diagnosed as asthma. Patients with RSV bronchiolitis hospitalization histories had higher risk to have future asthma [odds ratio (OR)=3.77 (2.30-6.20), p value < 0.001; hazard ratio (HR)=2.56 (1.81-3.62), p value < 0.001]. Palivizumab injection could reduce future asthma development through inhibition of RSV bronchiolitis hospitalization (p value=0.027). Asthmatic children post palivizumab injection had lesser active asthma duration than those without injection (p value=0.005). <Conclusion> BPD children with hospitalization for RSV bronchiolitis had higher risk to develop asthma than those without RSV infection. Prophylactic palivizumab may reduce later asthma development through inhibition of RSV bronchiolitis infection. In those already developing asthma, palivizumab could reduce active asthma duration.