新型冠状病毒感染相关儿童多系统炎症综合征的病例对照研究  

Multisystem inflammatory syndrome in children associated with novel coronavirus infection:A case-control study

作　　者：邱小龙 李小莉 王兆灵 吴菱 樊慧苏[4] 姜丽娇[5] 方玉红 邹丽霞[1] 黄先枚 卢美萍[1] QIU Xiaolong;LI Xiaoli;WANG Zhaoling;WU Ling;FAN Huisu;JIANG Lijiao;FANG Yuhong;ZOU Lixia;HUANG Xianmei;LU Meiping(Department of Rheumatology Immunology and Allergy,The Children's Hospital,Zhejiang University School of Medical,National Clinical Research Center for Child Health,Hangzhou 310052,China;Department of Pediatrics,Affiliated Hangzhou First People's Hospital,School Of Medicine,Westlake University,Hangzhou 310000,China;Women and Children's Hospital Affiliated to Ningbo University,Ningbo 315000,China;Lishui People's Hospital,Zhejiang Province,Lishui 323000,China;Taizhou Hospital,Zhejiang Province,Taizhou 317000,China;The First People's Hospital of Tonglu County,Zhejiang Province,Hangzhou 311500,China)

机构地区：[1]浙江大学医学院附属儿童医院风湿免疫过敏科,国家儿童健康与疾病临床医学研究中心,杭州310052 [2]西湖大学医学院附属杭州市第一人民医院儿科,杭州310000 [3]宁波大学附属妇女儿童医院,宁波315000 [4]浙江省丽水市人民医院,丽水323000 [5]浙江省台州医院,台州317000 [6]浙江省桐庐县第一人民医院,杭州311500

出　　处：《中国循证儿科杂志》2024年第3期211-215,共5页Chinese Journal of Evidence Based Pediatrics

基　　金：浙江省“尖兵”“领雁”研发攻关计划资助项目:2023C03032;国家自然科学基金资助项目:82070027。

摘　　要：背景儿童多系统炎症综合征(MIS-C)与新型冠状病毒(SARS-CoV-2)感染相关,既往文献研究多为病例报告或综述,难治性MIS-C仅为个案报告。目的探讨难治性MIS-C与非难治性MIS-C的区别,提高对MIS-C的疾病认识。设计病例对照研究。方法收集浙江地区6家医院的MIS-C连续病例,将一线治疗后持续发热和/或终末器官受累定义为难治性MIS-C(病例组),余为非难治性MIS-C(对照组),总结两组患儿的基本信息、临床表现、实验室检查、影像学检查、治疗药物及疗效等临床资料,并行单因素分析。主要结局指标MIS-C临床特征。结果23例MIS-C患儿进入本文分析,发病年龄(4.8±3.4)岁,SARS-CoV-2感染或接触史与诊断MIS-C间隔时间(30±9)d。病例组4例,男女各2例;对照组19例,男10例,女9例。两组基本信息、临床表现和严重并发症[颅内出血、巨噬细胞活化综合征(MAS)、冠脉扩张、脑炎]差异均无统计学意义。影像学表现中,病例组≥2个浆膜腔受累(75%vs 16%)比例和心包积液(75%vs 11%)比例均高于对照组;实验室检查中,病例组PLT计数低于对照,PCT、D-二聚体、IL-6、IL-10和INF-γ均高于对照组;差异均有统计学意义。对照组单用IVIG治疗8例(42%),单用糖皮质激素治疗4例(21%),IVIG+糖皮质激素治疗6例(32%),病例组4例在糖皮质激素+IVIG二联用药加用托珠单抗治疗。23例均好转出院,无死亡病例。对照组1例并发严重颅内出血患儿,出院时、6月随访时遗留偏瘫,6月后失访;1例并发冠脉扩张患儿出院后1个月随访时恢复正常。结论MIS-C可导致颅内出血、MAS、冠脉扩张等严重并发症,预后相对较好,难治性MIS-C患儿炎症反应更重,多系统受累更明显,托珠单抗治疗有效。Background Multisystem inflammatory syndrome in children(MIS-C)is associated with SARS-CoV-2 infection.Most previous studies on MIS-C are case reports or reviews,with refractory MIS-C only documented in individual case reports.Objective To explore the differences between refractory MIS-C and non-refractory MIS-C and to enhance understanding of the disease.Design Case-control study.Methods Consecutive cases of MIS-C from six hospitals in Zhejiang Province were collected.Refractory MIS-C was defined as persistent fever and/or terminal organ involvement after first-line treatment(case group),while the remaining cases were classified as non-refractory MIS-C(control group).The basic information,clinical manifestations,laboratory tests,imaging findings,treatment,and efficacy of the two groups were summarized and analyzed using univariate analysis.Main outcome measures Clinical characteristics of MIS-C.Results A total of 23 children with MIS-C were included in this analysis,with an average onset age of 4.8±3.4 years.The interval between SARS-CoV-2 infection or exposure and MIS-C diagnosis was 30±9 days.The case group included 4 children(2 males and 2 females),while the control group included 19 children(10 males and 9 females).There were no statistically significant differences between the two groups in terms of basic information,clinical manifestations,or severe complications.In imaging findings,the case group had higher proportions of involvement in≥2 serous cavities(75%vs.16%)and pericardial effusion(75%vs.11%)compared to the control group.In laboratory tests,the case group showed lower platelet(PLT)counts,higher procalcitonin(PCT),and D-dimer levels,as well as elevated levels of IL-6,IL-10,and IFN-γ,all of which were statistically significant.In the control group,8 cases(42%)were treated with IVIG alone,4 cases(21%)with corticosteroids alone,and 6 cases(32%)with a combination of IVIG and corticosteroids.In the case group,all 4 children received additional tocilizumab treatment on top of corticosteroids and IVIG

关 键 词：新型冠状病毒 儿童多系统炎症综合征 冠脉扩张 颅内出血 巨噬细胞活化综合征 托珠单抗 

分 类 号：R725.1[医药卫生—儿科]