Department of Pediatric Cardiology and Pediatric Intensive Care, Hospital Infantil Virgen del Rocio, Institute of Biomedicine IBIS, CIBER-CV, Seville, Spain (I.V.).
Department of Pediatrics - Pediatric Cardiology / Neonatology, Cambridge University Hospitals and University of Cambridge School of Clinical Medicine, UK (Y.S.).
Circulation. 2021 Jan 5;143(1):21-32. doi: 10.1161/CIRCULATIONAHA.120.050065. Epub 2020 Nov 9.
BACKGROUND: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. METHODS: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. RESULTS: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. CONCLUSIONS: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.
背景：本研究旨在记录与 2019 年冠状病毒病（COVID-19）感染相关的新型多系统炎症综合征患儿的心血管临床发现、心脏影像学和实验室标志物。
方法：本实时在线调查得到了欧洲儿科和先天性心脏病协会心脏影像学和心血管重症监护工作组的认可。2020 年 2 月 1 日至 6 月 6 日期间，因炎症综合征和急性心血管并发症而住院的 0 至 18 岁儿童被纳入研究。
结果：来自欧洲 17 个国家 55 个中心的 286 名儿童被纳入研究。中位年龄为 8.4 岁（四分位距 3.8-12.4 岁），67%为男性。最常见的心血管并发症为休克、心律失常、心包积液和冠状动脉扩张。超过一半的患者左心室射血分数降低，大多数患者心肌肌钙蛋白升高。大多数患者入院时炎症的生化标志物升高：C 反应蛋白、血清铁蛋白、降钙素原、氨基末端 B 型利钠肽前体、白细胞介素-6 水平和 D-二聚体升高。心脏和生化参数升高的程度与需要重症监护支持呈统计学显著相关（<0.05）。聚合酶链反应检测严重急性呼吸综合征冠状病毒 2 阳性率为 33.6%，免疫球蛋白 M 和免疫球蛋白 G 抗体阳性率分别为 15.7%和 43.6%，当检测时。研究队列中有 1 名儿童死亡。
结论：在与 COVID-19 大流行相关的多系统炎症综合征患儿中，心脏受累很常见。大多数患儿的氨基末端 B 型利钠肽前体、铁蛋白、D-二聚体和肌钙蛋白水平显著升高，同时 C 反应蛋白和降钙素原水平也升高。与 COVID-19 成人患者相比，尽管多系统受累、炎症标志物显著升高和需要重症监护支持，COVID-19 相关多系统炎症综合征患儿的死亡率并不常见。
Clin Chem Lab Med. 2021-1-8
Lancet Child Adolesc Health. 2021-5
Front Pediatr. 2025-4-30
Zotero 插件