Abstract

Background

Clinical manifestations of respiratory syncytial virus (RSV) infection vary widely from mild, self-limiting illness to severe life-threatening disease. There are gaps in knowledge of biomarkers to objectively define severe disease and predict clinical outcomes.

Methods

A systematic search was performed, 1945–March 2019 in databases Ovid Medline, Embase, Global health, Scopus, and Web of Science. Risk of bias was assessed using the Cochrane tool.

Results

A total of 25 132 abstracts were screened and studies were assessed for quality, risk of bias, and extracted data; 111 studies met the inclusion criteria. RSV severity was correlated with antibody titers, reduced T and B cells, dysregulated innate immunity, neutrophil mobilization to the lungs and blood, decreased Th1 response, and Th2 weighted shift. Microbial exposures in respiratory tract may contribute to neutrophil mobilization to the lungs of the infants with severe RSV compared with mild RSV disease.

Conclusions

Although a wide range of biomarkers have been associated with RSV disease severity, robust validated biomarkers are lacking. This review illustrates the broad heterogeneity of study designs and high variability in the definition of severe RSV disease. Prospective studies are required to validate biomarkers. Additional research investigating epigenetics, metabolomics, and microbiome holds promise for novel biomarkers.

中文翻译：

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儿童呼吸道合胞病毒感染疾病严重程度的生物标志物：系统文献综述。

摘要

背景

呼吸道合胞病毒（RSV）感染的临床表现从轻度自限性疾病到严重威胁生命的疾病，差异很大。生物标志物的知识尚不足以客观地定义严重疾病并预测临床结果。

方法

1945年至2019年3月，在Ovid Medline，Embase，Global health，Scopus和Web of Science数据库中进行了系统的搜索。使用Cochrane工具评估偏倚风险。

结果

总共筛选了25 132个摘要，并对研究质量，偏倚风险和提取的数据进行了评估；111项研究符合纳入标准。RSV严重程度与抗体滴度，T细胞和B细胞减少，先天免疫功能失调，中性粒细胞向肺和血液的动员，Th1反应降低和Th2加权移位相关。与轻度RSV疾病相比，严重RSV婴儿的呼吸道微生物暴露可能有助于中性粒细胞向肺部的动员。

结论

尽管各种各样的生物标志物都与RSV疾病的严重程度有关，但缺乏可靠的经过验证的生物标志物。这篇综述说明了研究设计的广泛异质性和严重RSV疾病定义的高度变异性。需要进行前瞻性研究以验证生物标志物。有关表观遗传学，代谢组学和微生物组的其他研究为新型生物标记物带来了希望。