Aronoff Stephen C, Hall Ashleigh, Del Vecchio Michael T
Department of Pediatrics, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA.
St Christopher's Hospital for Children, Philadelphia, Pennsylvania, USA.
J Pediatric Infect Dis Soc. 2020 Dec 31;9(6):746-751. doi: 10.1093/jpids/piaa112.
The clinical manifestations and natural history of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-related multisystem inflammatory syndrome in children (MIS-C) are poorly defined. Using a systematic review of individual cases and case series and collating elements of the clinical course, the objective of this study was to provide a detailed clinical description and natural history of MIS-C.
Case reports and series of MIS-C were recovered from repeated MEDLINE searches, a single EMBASE search, and table of contents reviews of major general medicine and pediatric journals performed between June 3 and July 23, 2020. Fever, evidence of inflammation, and evidence of organ dysfunction were required for inclusion.
MEDLINE and EMBASE searches produced 129 articles, and 10 articles were identified from journal contents or article bibliographies; 16 reports describing 505 children with MIS-C comprise this review. Thirty-two children (14.7%) had negative results for SARS-CoV-2 by nucleic acid and/or antibody testing. The weighted median age was 9 years (6 months to 20 years). Clinical findings included fever (100%), gastrointestinal symptoms (88.0%), rash (59.2%), conjunctivitis (50.0%), cheilitis/ "strawberry tongue" (55.7%), or extremity edema/erythema (47.5%). Median serum C-reactive protein, ferritin, fibrinogen, and D-dimer concentrations were above the normal range. Intravenous gammaglobulin (78.1%) and methylprednisolone/prednisone (57.6%) were the most common therapeutic interventions; immunomodulation was used in 24.3% of cases. Myocardial dysfunction requiring ionotropic support (57.4%) plus extracorporeal membrane oxygenation (5.3%), respiratory distress requiring mechanical ventilation (26.1%), and acute kidney injury (11.9%) were the major complications; anticoagulation was used commonly (54.4%), but thrombotic events occurred rarely (3.5%). Seven (1.4%) children died.
MIS-C following SARS-CoV-2 infection frequently presents with gastrointestinal complaints and/or rash; conjunctivitis, cheilitis, and/or extremity changes also occur frequently. Serious complications occur frequently and respond to aggressive supportive therapy.
儿童严重急性呼吸综合征冠状病毒2（SARS-CoV-2）相关多系统炎症综合征（MIS-C）的临床表现和自然病史尚不明确。本研究旨在通过对个体病例和病例系列进行系统评价并整理临床病程要素，详细描述MIS-C的临床特征和自然病史。
通过多次检索MEDLINE、单次检索EMBASE以及查阅2020年6月3日至7月23日期间主要综合医学和儿科杂志的目录，收集MIS-C的病例报告和系列病例。纳入标准为发热、炎症证据和器官功能障碍证据。
MEDLINE和EMBASE检索共得到129篇文章，从杂志目录或文章参考文献中又识别出10篇文章；本综述纳入了16篇描述505例MIS-C患儿的报告。32名儿童（14.7%）的SARS-CoV-2核酸和/或抗体检测结果为阴性。加权年龄中位数为9岁（6个月至20岁）。临床表现包括发热（100%）、胃肠道症状（88.0%）、皮疹（59.2%）、结膜炎（50.0%）、唇炎/“草莓舌”（55.7%）或肢体水肿/红斑（47.5%）。血清C反应蛋白、铁蛋白、纤维蛋白原和D-二聚体浓度中位数高于正常范围。静脉注射免疫球蛋白（78.1%）和甲泼尼龙/泼尼松（57.6%）是最常见的治疗干预措施；24.3%的病例使用了免疫调节治疗。主要并发症包括需要使用血管活性药物支持的心肌功能障碍（57.4%）加体外膜肺氧合（5.3%）、需要机械通气的呼吸窘迫（26.1%）和急性肾损伤（11.9%）；抗凝治疗常用（54.4%），但血栓形成事件很少发生（3.5%）。7名儿童（1.4%）死亡。
SARS-CoV-2感染后的MIS-C常表现为胃肠道症状和/或皮疹；结膜炎、唇炎和/或肢体改变也很常见。严重并发症频繁发生，积极的支持治疗有效。
