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美国纽约州儿童多系统炎症综合征的描述性分析
2020-06-30 18:32

美国纽约州卫生部Elizabeth M. Dufort团队对纽约州儿童多系统炎症综合症(MIS-C)的临床特征进行了分析。2020年6月29日,该成果发表在《新英格兰医学杂志》上。

MIS-C与Covid-19相关。纽约州卫生部(NYSDOH)建立了全州范围内的主动监视措施,对住院的MIS-C患者进行描述。

纽约州的医院报告了21岁以下的川崎病、中毒性休克综合征、心肌炎和潜在MIS-C的住院患者,并将病历发送给NYSDOH。研究组对2020年3月1日至5月10日符合MIS-C定义患者的临床表现、并发症和结局进行了描述性分析。

截至2020年5月10日,NYSDOH总共报告了191起潜在病例。在95例确诊MIS-C(实验室确诊的急性或近期SARS-CoV-2感染)和4例疑似MIS-C(符合临床和流行病学标准)的患者中,有53例(54%)是男性;78名患者中有31名(40%)是黑人,而85名患者中有31名(36%)是西班牙裔。

31例患者(31%)为0-5岁,42例(42%)为6-12岁,26例(26%)为13-20岁。这些患者全都表现出发烧或寒颤;97%表现为心动过速,80%有胃肠道症状,60%发生皮疹,56%结膜充血,27%粘膜改变。分别在100%、91%和71%的患者中发现C反应蛋白、d-二聚体和肌钙蛋白水平升高。62%的患者接受了血管加压药支持,53%的患者发生心肌炎,80%的患者进入重症监护病房,2例患者死亡。中位住院时间为6天。

总之,纽约州MIS-C的出现与SARS-CoV-2的广泛传播相吻合。这种具有皮肤病学、粘膜皮肤和胃肠道表现的高炎症综合症与心脏功能障碍有关。

附:英文原文

Title: Multisystem Inflammatory Syndrome in Children in New York State

Author: Elizabeth M. Dufort, M.D.,, Emilia H. Koumans, M.D., M.P.H.,, Eric J. Chow, M.D., M.P.H.,, Elizabeth M. Rosenthal, M.P.H.,, Alison Muse, M.P.H.,, Jemma Rowlands, M.P.H.,, Meredith A. Barranco, M.P.H.,, Angela M. Maxted, D.V.M., Ph.D.,, Eli S. Rosenberg, Ph.D.,, Delia Easton, Ph.D.,, Tomoko Udo, Ph.D.,, Jessica Kumar, D.O.,, Wendy Pulver, M.S.,, Lou Smith, M.D.,, Brad Hutton, M.P.H.,, Debra Blog, M.D., M.P.H.,, and Howard Zucker, M.D.

Issue&Volume: 2020-06-29

Abstract: BACKGROUND

A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome.

METHODS

Hospitals in New York State reported cases of Kawasaki’s disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.

RESULTS

As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.

CONCLUSIONS

The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

DOI: 10.1056/NEJMoa2021756

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2021756

 

The New England Journal of Medicine:《新英格兰医学杂志》,创刊于1812年。隶属于美国麻省医学协会,最新IF:70.67
官方网址:http://www.nejm.org/
投稿链接:http://www.nejm.org/page/author-center/home


本期文章:《新英格兰医学杂志》:Online/在线发表

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