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美国儿童和青少年多系统炎症综合征的流行病学和临床分析
2020-06-30 18:34

美国疾病控制和预防中心Manish M. Patel联合波士顿儿童医院Adrienne G. Randolph团队近期分析了全美儿童和青少年多系统炎性综合征的特征。相关论文发表在2020年6月29日出版的《新英格兰医学杂志》上。

考虑到儿童多系统炎性综合征(MIS-C)的临床和公共卫生影响,了解MIS-C的流行病学和临床病程及其与Covid-19的时间相关性尤为重要。

研究组于2020年3月15日至5月20日在美国各地的儿科健康中心进行了MIS-C的针对性监视。病例定义包括六个标准:导致住院的严重疾病,年龄小于21岁,发烧持续24小时以上,炎症的实验室证据,多系统器官受累,以及经RT-PCR和抗体检测确诊的SARS-CoV-2感染或过去一个月暴露Covid-19的患者。

研究组共报告了26个州的186名MIS-C患者。中位年龄为8.3岁,男性占62%。73%的患者先前健康,70%通过RT-PCR或抗体检测出SARS-CoV-2阳性,88%在2020年4月16日之后住院。器官系统受累中胃肠道系统占92%、心血管系统占80%,血液系统占76%,皮肤粘膜占74%,呼吸系统占70%。

中位住院时间为7天。80%的患者接受重症监护,20%接受机械通气,48%接受血管活性支持,2%死亡。8%的患者发生冠状动脉瘤(z评分≥2.5),40%的患者表现为川崎病样特征。92%的患者至少四种生物标志物升高,提示患有炎症。大多数患者接受了免疫调节治疗:77%的患者使用静脉内免疫球蛋白,49%使用糖皮质激素,20%使用白细胞介素6或1RA抑制剂。

研究结果表明,与SARS-CoV-2相关的MIS-C导致先前健康的儿童和青少年罹患严重且威胁生命的疾病。

附:英文原文

Title: Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Author: 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.

Issue&Volume: 2020-06-29

Abstract: BACKGROUND

Understanding the epidemiology and clinical course of multisystem inflammatory syndrome in children (MIS-C) and its temporal association with coronavirus disease 2019 (Covid-19) is important, given the clinical and public health implications of the syndrome.

METHODS

We conducted targeted surveillance for MIS-C from March 15 to May 20, 2020, in pediatric health centers across the United States. The case definition included six criteria: serious illness leading to hospitalization, an age of less than 21 years, fever that lasted for at least 24 hours, laboratory evidence of inflammation, multisystem organ involvement, and evidence of infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) based on reverse-transcriptase polymerase chain reaction (RT-PCR), antibody testing, or exposure to persons with Covid-19 in the past month. Clinicians abstracted the data onto standardized forms.

RESULTS

We report on 186 patients with MIS-C in 26 states. The median age was 8.3 years, 115 patients (62%) were male, 135 (73%) had previously been healthy, 131 (70%) were positive for SARS-CoV-2 by RT-PCR or antibody testing, and 164 (88%) were hospitalized after April 16, 2020. Organ-system involvement included the gastrointestinal system in 171 patients (92%), cardiovascular in 149 (80%), hematologic in 142 (76%), mucocutaneous in 137 (74%), and respiratory in 131 (70%). The median duration of hospitalization was 7 days (interquartile range, 4 to 10); 148 patients (80%) received intensive care, 37 (20%) received mechanical ventilation, 90 (48%) received vasoactive support, and 4 (2%) died. Coronary-artery aneurysms (z scores ≥2.5) were documented in 15 patients (8%), and Kawasaki’s disease–like features were documented in 74 (40%). Most patients (171 [92%]) had elevations in at least four biomarkers indicating inflammation. The use of immunomodulating therapies was common: intravenous immune globulin was used in 144 (77%), glucocorticoids in 91 (49%), and interleukin-6 or 1RA inhibitors in 38 (20%).

CONCLUSIONS

Multisystem inflammatory syndrome in children associated with SARS-CoV-2 led to serious and life-threatening illness in previously healthy children and adolescents.

DOI: 10.1056/NEJMoa2021680

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2021680

 

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


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