本文由小咖机器人翻译整理

期刊来源：Lancet

原文链接：https://doi.org/10.1016/S0140-6736(24)00138-7

摘要内容如下：

背景

早产儿是呼吸道合胞病毒（RSV）引起的严重急性下呼吸道感染（ALRI）的高危人群。在本研究中，我们旨在评估妊娠37周前出生的婴幼儿中RSV相关ALRI的全球疾病负担和危险因素。

方法

我们对1995年1月1日至2021年12月31日期间发表的研究的汇总数据进行了系统回顾和荟萃分析，这些数据来自MEDLINE、EMBASE和全球健康（Global Health），以及呼吸道病毒全球流行病学网络（Respiratory Virus Global Epidemiology Network）共享的关于呼吸道传染病的个体参与者数据。我们评估了RSV相关的ALRI在社区、住院、住院死亡率和2岁以下早产儿童总死亡率中的发病率。我们进行了两个阶段的随机效应荟萃回归分析，说明了实际年龄组、胎龄带（早期早产，<32周胎龄[WGA]和晚期早产，32至<37周胎龄[WGA]），以及从2000年至2019年5年间的变化。使用个体参与者数据，我们评估了围产期、社会人口统计学和家庭因素，以及RSV相关的ALRI发病率、住院、通过两阶段荟萃分析（多因素Logistic回归分析和随机效应荟萃分析）估计合并比值比（OR），得出三个严重结果组（住院时间较长[>4天]，使用补充氧气和机械通气，或重症监护室入院）。本研究在普洛斯彼罗注册，CRD42021269742。

调查结果

我们纳入了47项文献研究和17项由参与研究者提供的个体参与者水平数据的研究。我们估计，在2019年，全世界有1650000（95%不确定性范围[UR]1350000-1990000）例RSV相关的ALRI事件，533000（385000-730000）例RSV相关的住院病例，3050（1080-8620）例RSV相关的住院死亡病例，以及26760（11190-46240）例可归因于RSV的死亡病例。在早期早产儿中，RSV相关的ALRI发生率和住院率显著高于任何胎龄出生的所有婴儿（不同年龄组和结局的比率[RR]范围为1.69~3.87）。在出生后第二年，早期早产儿和幼儿的发病率相似，但住院率（RR 2.26[95%UR 1.27-3.98]）仍显著高于所有婴儿和幼儿。尽管晚期早产儿的RSV相关ALRI发病率与所有小于1岁的婴儿相似，但他们在前6个月的RSV相关ALRI住院率更高（RR 1.93[1.11-3.26]）。总体而言，在任何胎龄的所有婴儿中，早产儿占RSV相关ALRI住院的25%（95%UR 16-37）。早产儿RSV相关的ALRI住院病死率与所有婴儿相似。与RSV相关的ALRI发病率相关的因素主要是围产期和社会人口学特征，与感染的严重后果相关的因素主要是基础疾病，包括先天性心脏病、气管造口术、支气管肺发育不良、慢性肺病或唐氏综合征（OR值为1.40~4.23）。

解释

早产儿面临不成比例的高RSV相关疾病负担，占RSV住院负担的25%。早期早产儿有相当大的RSV住院负担，持续到生命的第二年。RSV预防产品可通过预防早产儿RSV相关的ALRI和感染的严重后果，对公共卫生产生重大影响。

英文原文如下：

Abstracts

BACKGROUND  Infants and young children born prematurely are at high risk of severe acute lower respiratory infection (ALRI) caused by respiratory syncytial virus (RSV). In this study, we aimed to assess the global disease burden of and risk factors for RSV-associated ALRI in infants and young children born before 37 weeks of gestation.

METHODS  We conducted a systematic review and meta-analysis of aggregated data from studies published between Jan 1, 1995, and Dec 31, 2021, identified from MEDLINE, Embase, and Global Health, and individual participant data shared by the Respiratory Virus Global Epidemiology Network on respiratory infectious diseases. We estimated RSV-associated ALRI incidence in community, hospital admission, in-hospital mortality, and overall mortality among children younger than 2 years born prematurely. We conducted two-stage random-effects meta-regression analyses accounting for chronological age groups, gestational age bands (early preterm, <32 weeks gestational age [wGA], and late preterm, 32 to <37 wGA), and changes over 5-year intervals from 2000 to 2019. Using individual participant data, we assessed perinatal, sociodemographic, and household factors, and underlying medical conditions for RSV-associated ALRI incidence, hospital admission, and three severity outcome groups (longer hospital stay [>4 days], use of supplemental oxygen and mechanical ventilation, or intensive care unit admission) by estimating pooled odds ratios (ORs) through a two-stage meta-analysis (multivariate logistic regression and random-effects meta-analysis). This study is registered with PROSPERO, CRD42021269742.

FINDINGS  We included 47 studies from the literature and 17 studies with individual participant-level data contributed by the participating investigators. We estimated that, in 2019, 1 650 000 (95% uncertainty range [UR] 1 350 000-1 990 000) RSV-associated ALRI episodes, 533 000 (385 000-730 000) RSV-associated hospital admissions, 3050 (1080-8620) RSV-associated in-hospital deaths, and 26 760 (11 190-46 240) RSV-attributable deaths occurred in preterm infants worldwide. Among early preterm infants, the RSV-associated ALRI incidence rate and hospitalisation rate were significantly higher (rate ratio [RR] ranging from 1·69 to 3·87 across different age groups and outcomes) than for all infants born at any gestational age. In the second year of life, early preterm infants and young children had a similar incidence rate but still a significantly higher hospitalisation rate (RR 2·26 [95% UR 1·27-3·98]) compared with all infants and young children. Although late preterm infants had RSV-associated ALRI incidence rates similar to that of all infants younger than 1 year, they had higher RSV-associated ALRI hospitalisation rate in the first 6 months (RR 1·93 [1·11-3·26]). Overall, preterm infants accounted for 25% (95% UR 16-37) of RSV-associated ALRI hospitalisations in all infants of any gestational age. RSV-associated ALRI in-hospital case fatality ratio in preterm infants was similar to all infants. The factors identified to be associated with RSV-associated ALRI incidence were mainly perinatal and sociodemographic characteristics, and factors associated with severe outcomes from infection were mainly underlying medical conditions including congenital heart disease, tracheostomy, bronchopulmonary dysplasia, chronic lung disease, or Down syndrome (with ORs ranging from 1·40 to 4·23).

INTERPRETATION  Preterm infants face a disproportionately high burden of RSV-associated disease, accounting for 25% of RSV hospitalisation burden. Early preterm infants have a substantial RSV hospitalisation burden persisting into the second year of life. Preventive products for RSV can have a substantial public health impact by preventing RSV-associated ALRI and severe outcomes from infection in preterm infants.

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