Maheshwari Anu, Mahto Deonath, Kumar Virendra, Gulati Sameer, Pemde Harish, Saha Abhijeet, Mukherjee Sharmila B, Pandit Kaveri, Paharia Konpal, Basu Srikanta
Department of Pediatrics, Kalawati Saran Children's Hospital and Lady Hardinge Medical college, New Delhi, India.
Department of Internal medicine, Division of Rheumatology, VMMC and Safdarjung Hospital, New Delhi, India.
J Paediatr Child Health. 2022 Jan;58(1):136-140. doi: 10.1111/jpc.15675. Epub 2021 Aug 2.
The SARS-CoV-2 pandemic is characterised by multiple reports of paediatric multisystem inflammatory disease or multisystem inflammatory syndrome in children (MIS-C) with Kawasaki disease-like features often complicated by myocarditis, shock and macrophage activation syndrome. Certain clinical and laboratory markers may be used to identify high risk cases.
All sequentially admitted patients hospitalised between April 2020 and October 2020, who met the WHO case definition for MIS-C were included. Data included patient demographic information, presenting symptoms, organ dysfunction and laboratory parameters. SARS-CoV-2 infection was diagnosed by nasopharyngeal swab real-time reverse transcription-polymerase chain reaction and/or rapid antibody test for SARS-CoV-2 as recommended. The clinical and laboratory criteria were compared in the survival and non-survival groups.
A total of 29 patients with MIS-C were treated during the study period. There were 21 survivors and 8 non-survivors. The non-survivors had more neurocognitive and respiratory symptoms along with increased incidence of myocarditis compared with survivors. The serum levels of CPK-MB, D-dimer, ferritin and triglyceride were significantly raised in non-survivors as compared to survivors.
The non-survivor group had higher CPK and greater proportion of children with troponin-T elevation indicating higher incidence of myocardial injury and necrosis. The D-dimer, ferritin and triglyceride were also higher in the mortality group, indicating the greater extent of inflammatory damage in this group.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）大流行的特点是多份关于儿童多系统炎症性疾病或儿童多系统炎症综合征（MIS-C）的报告，其具有川崎病样特征，常并发心肌炎、休克和巨噬细胞活化综合征。某些临床和实验室指标可用于识别高危病例。
纳入2020年4月至2020年10月期间所有按顺序收治且符合世界卫生组织MIS-C病例定义的住院患者。数据包括患者人口统计学信息、出现的症状、器官功能障碍和实验室参数。按照推荐，通过鼻咽拭子实时逆转录聚合酶链反应和/或SARS-CoV-2快速抗体检测诊断SARS-CoV-2感染。比较生存组和非生存组的临床和实验室标准。
在研究期间共治疗了29例MIS-C患者。有21例幸存者和8例非幸存者。与幸存者相比，非幸存者有更多的神经认知和呼吸道症状，心肌炎发病率也更高。与幸存者相比，非幸存者的肌酸磷酸激酶同工酶（CPK-MB）、D-二聚体、铁蛋白和甘油三酯血清水平显著升高。
非生存组的CPK较高，肌钙蛋白-T升高的儿童比例较大，表明心肌损伤和坏死的发生率较高。死亡组的D-二聚体、铁蛋白和甘油三酯也较高，表明该组炎症损伤程度更大。
