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美国儿童和青少年中的多系统炎症综合征
Multisystem Inflammatory Syndrome in U.S. Children and Adolescents


Leora R. Feldstein ... 呼吸系统疾病 妇产科和儿科 • 2020.07.23
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• 儿童多系统炎症综合征——COVID-19大流行期间面临的新挑战 • 2020年1月初在中国武汉儿童中检出的COVID-19 • 儿童感染SARS-CoV-2的情况

摘要


背景

鉴于儿童多系统炎症综合征(MIS-C)对医疗系统和公共卫生系统的影响,了解该综合征的流行病学特征和临床病程及其与2019冠状病毒病(COVID-19)的时间关联非常重要。

 

方法

从2020年3月15日至5月20日,我们在美国各地的儿科医疗中心对MIS-C进行了针对性的监测。疾病定义包括6项标准:需要住院的重症疾病,年龄<21岁,发热持续至少24小时,实验室结果证实为炎症,多系统器官受累,以及有证据证实患者感染严重急性呼吸综合征冠状病毒2(SARS-CoV-2);前述证据包括反转录酶聚合酶链反应(RT-PCR)、抗体检测或在过去1个月内与COVID-19患者有密切接触史。临床医师将数据转化为标准化格式。

 

结果

本文报告的186例MIS-C患者分布在26个州。患者的中位年龄为8.3岁,男性115例(62%),既往体健的患者为135例(73%),通过RT-PCR或抗体检测证实SARS-CoV-2阳性者为131例(70%),2020年4月16日后住院者为164例(88%)。受累的器官系统包括消化系统(171例[92%])、心血管系统(149例[80%])、血液系统(142例[76%])、皮肤黏膜(137例[74%])和呼吸系统(131例[70%])。中位住院时间为7日(四分位距,4~10);148例患者(80%)入住重症监护病房,37例(20%)接受机械通气治疗,90例(48%)接受血管活性药物支持,4例(2%)死亡。15例患者(8%)证实出现冠状动脉瘤(z评分≥2.5),74例(40%)的病情类似川崎病。大多数患者(171例[92%])出现至少4项生物标志物(提示炎症)升高。大部分患者接受免疫调节药物治疗:144例(77%)静脉输注免疫球蛋白,91例(49%)接受糖皮质激素治疗,38例(20%)接受白细胞介素-6或1Ra抑制剂治疗。

 

结论

与SARS-CoV-2相关的儿童多系统炎症综合征可导致既往体健的儿童和青少年患上严重且危及生命的疾病(由美国疾病预防控制中心[CDC]资助)。





作者信息

Leora R. Feldstein, Ph.D., Erica B. Rose, Ph.D., Steven M. Horwitz, M.D., Jennifer P. Collins, M.D., Margaret M. Newhams, M.P.H., Mary Beth F. Son, M.D., Jane W. Newburger, M.D., M.P.H., Lawrence C. Kleinman, M.D., M.P.H., Sabrina M. Heidemann, M.D., Amarilis A. Martin, M.D., Aalok R. Singh, M.D., Simon Li, M.D., M.P.H., Keiko M. Tarquinio, M.D., Preeti Jaggi, M.D., Matthew E. Oster, M.D., M.P.H., Sheemon P. Zackai, M.D., Jennifer Gillen, M.D., Adam J. Ratner, M.D., M.P.H., Rowan F. Walsh, M.D., Julie C. Fitzgerald, M.D., Ph.D., Michael A. Keenaghan, M.D., Hussam Alharash, M.D., Sule Doymaz, M.D., Katharine N. Clouser, M.D., John S. Giuliano, Jr., M.D., Anjali Gupta, M.D., Robert M. Parker, D.O., Aline B. Maddux, M.D., Vinod Havalad, M.D., Stacy Ramsingh, M.D., Hulya Bukulmez, M.D., Tamara T. Bradford, M.D., Lincoln S. Smith, M.D., Mark W. Tenforde, M.D., Ph.D., Christopher L. Carroll, M.D., Becky J. Riggs, M.D., Shira J. Gertz, M.D., Ariel Daube, M.D., Amanda Lansell, M.D., Alvaro Coronado Munoz, M.D., Charlotte V. Hobbs, M.D., Kimberly L. Marohn, M.D., Natasha B. Halasa, M.D., M.P.H., Manish M. Patel, M.D., and Adrienne G. Randolph, M.D. for the Overcoming COVID-19 Investigators, and the CDC COVID-19 Response Team*
From the COVID-19 Response, Centers for Disease Control and Prevention (L.R.F., E.B.R., J.P.C., M.W.T., M.M.P.), and the Division of Critical Care Medicine, Department of Pediatrics (K.M.T.), the Department of Pediatrics, Division of Infectious Diseases (P.J.), and the Department of Pediatrics, Division of Cardiology (M.E.O.), Emory University School of Medicine, Atlanta; Public Health Service Commissioned Corps, Rockville (L.R.F., E.B.R., M.M.P.), and the Department of Anesthesiology and Critical Care Medicine, Division of Pediatric Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore (B.J.R.) — both in Maryland; the Department of Pediatrics, Division of Pediatric Critical Care, Bristol-Myers Squibb Children’s Hospital, Robert Wood Johnson Medical School, Rutgers University (S.M. Horwitz), the Department of Pediatrics, Division of Population Health, Quality, and Implementation Sciences (PopQuIS), Rutgers Robert Wood Johnson Medical School (L.C.K.), New Brunswick, the Department of Pediatrics, Division of Pediatric Cardiology, Children’s Hospital of New Jersey, Newark Beth Israel, Newark (R.F.W.), the Division of Hospital Medicine, Department of Pediatrics, Hackensack University Medical Center, Hackensack (K.N.C.), and the Division of Pediatric Critical Care, Department of Pediatrics, Saint Barnabas Medical Center, Livingston (S.J.G.) — all in New Jersey; the Department of Anesthesiology, Critical Care and Pain Medicine (M.M.N., A.G.R.), the Division of Immunology (M.B.F.S.), and the Department of Cardiology (J.W.N.), Boston Children’s Hospital, and the Departments of Pediatrics (M.B.F.S., J.W.N., A.G.R.) and Anaesthesia (A.G.R.), Harvard Medical School, Boston, and the Department of Pediatrics, Pediatric Critical Care, Baystate Medical Center, Springfield (K.L.M.) — both in Massachusetts; the Department of Pediatrics, Division of Pediatric Critical Care Medicine, Central Michigan University, Detroit (S.M. Heidemann, A.A.M.); the Pediatric Critical Care Division, Maria Fareri Children’s Hospital at Westchester Medical Center and New York Medical College, Valhalla (A.R.S., S.L.), Pediatric Critical Care Medicine, Department of Pediatrics, Icahn School of Medicine at the Mount Sinai Kravis Children’s Hospital (S.P.Z., J.G.), the Division of Pediatric Infectious Diseases, Departments of Pediatrics and Microbiology, New York University Grossman School of Medicine (A.J.R.), Pediatric Critical Care, New York City Health and Hospitals, Kings County Hospital (M.A.K., H.A.), the Division of Pediatric Critical Care, Department of Pediatrics, SUNY Downstate Health Sciences University (S.D.), and the Department of Pediatrics, Division of Pediatric Critical Care, Maimonides Children’s Hospital (A.D.), New York — all in New York; the Division of Critical Care, Department of Anesthesiology and Critical Care, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.C.F.); the Department of Pediatrics, Division of Critical Care, Yale University School of Medicine, New Haven (J.S.G., A.G.), and the Division of Critical Care, Connecticut Children’s, Hartford (R.M.P., C.L.C.) — both in Connecticut; the Department of Pediatrics, Section of Critical Care Medicine, University of Colorado School of Medicine and Children’s Hospital Colorado, Aurora (A.B.M.); the Division of Pediatric Critical Care Medicine, Department of Pediatrics, Advocate Children’s Hospital, Chicago (V.H., S.R.); the Department of Pediatrics, Division of Pediatric Rheumatology, MetroHealth Medical Center, Case Western Reserve University (H.B.), and the Division of Pediatric Hospital Medicine, Rainbow Babies and Children’s Hospital (A.L.), Cleveland; the Department of Pediatrics, Division of Cardiology, Louisiana State University Health Sciences Center and Children’s Hospital of New Orleans, New Orleans (T.T.B.); the Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Washington, Seattle (L.S.S.); the Pediatric Critical Care Division, Department of Pediatrics, University of Texas Health Science Center at Houston, Houston (A.C.M.); the Department of Pediatrics, Department of Microbiology, Division of Infectious Diseases, University of Mississippi Medical Center, Jackson (C.V.H.); and the Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville (N.B.H.). Address reprint requests to Dr. Patel at the Influenza Division, Centers for Disease Control and Prevention, 1600 Clifton Rd., MS H24-7, Atlanta, GA 30329, or at mpatel@cdc.gov; or to Dr. Randolph at Division of Critical Care Medicine, Boston Children’s Hospital, Bader 634, Boston, MA 02115, or at adrienne.randolph@childrens.harvard.edu. *Complete lists of members of the Overcoming COVID-19 Investigators and the CDC COVID-19 Response Team are provided in the Supplementary Appendix, available at NEJM.org.

 

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