Division of Cardiology, Children's National Hospital, Washington, DC, USA.
Department of Pediatrics, George Washington University, School of Medicine & Health Sciences, Washington, DC, USA.
Cardiol Young. 2022 May;32(5):718-726. doi: 10.1017/S1047951121003024. Epub 2021 Aug 5.
A novel paediatric disease, multi-system inflammatory syndrome in children, has emerged during the 2019 coronavirus disease pandemic.
To describe the short-term evolution of cardiac complications and associated risk factors in patients with multi-system inflammatory syndrome in children.
Retrospective single-centre study of confirmed multi-system inflammatory syndrome in children treated from 29 March, 2020 to 1 September, 2020. Cardiac complications during the acute phase were defined as decreased systolic function, coronary artery abnormalities, pericardial effusion, or mitral and/or tricuspid valve regurgitation. Patients with or without cardiac complications were compared with chi-square, Fisher's exact, and Wilcoxon rank sum.
Thirty-nine children with median (interquartile range) age 7.8 (3.6-12.7) years were included. Nineteen (49%) patients developed cardiac complications including systolic dysfunction (33%), valvular regurgitation (31%), coronary artery abnormalities (18%), and pericardial effusion (5%). At the time of the most recent follow-up, at a median (interquartile range) of 49 (26-61) days, cardiac complications resolved in 16/19 (84%) patients. Two patients had persistent mild systolic dysfunction and one patient had persistent coronary artery abnormality. Children with cardiac complications were more likely to have higher N-terminal B-type natriuretic peptide (p = 0.01), higher white blood cell count (p = 0.01), higher neutrophil count (p = 0.02), severe lymphopenia (p = 0.05), use of milrinone (p = 0.03), and intensive care requirement (p = 0.04).
Patients with multi-system inflammatory syndrome in children had a high rate of cardiac complications in the acute phase, with associated inflammatory markers. Although cardiac complications resolved in 84% of patients, further long-term studies are needed to assess if the cardiac abnormalities (transient or persistent) are associated with major cardiac events.
一种新的儿科疾病，儿童多系统炎症综合征，在 2019 年冠状病毒病大流行期间出现。
描述儿童多系统炎症综合征患者心脏并发症的短期演变及其相关危险因素。
对 2020 年 3 月 29 日至 2020 年 9 月 1 日期间确诊的儿童多系统炎症综合征进行回顾性单中心研究。急性期心脏并发症定义为收缩功能下降、冠状动脉异常、心包积液或二尖瓣和/或三尖瓣反流。比较有无心脏并发症的患者，采用卡方检验、Fisher 确切检验和 Wilcoxon 秩和检验。
共纳入 39 例年龄中位数（四分位距）为 7.8（3.6-12.7）岁的患儿。19 例（49%）患儿出现心脏并发症，包括收缩功能障碍（33%）、瓣膜反流（31%）、冠状动脉异常（18%）和心包积液（5%）。在最近一次随访时，中位数（四分位距）为 49（26-61）天，16/19（84%）例患儿的心脏并发症得到缓解。2 例患儿存在持续性轻度收缩功能障碍，1 例患儿存在持续性冠状动脉异常。有心脏并发症的患儿更可能有更高的 N 端脑利钠肽（p=0.01）、更高的白细胞计数（p=0.01）、更高的中性粒细胞计数（p=0.02）、严重的淋巴细胞减少（p=0.05）、使用米力农（p=0.03）和需要重症监护（p=0.04）。
儿童多系统炎症综合征患者急性期心脏并发症发生率高，与炎症标志物相关。尽管 84%的患者心脏并发症得到缓解，但仍需要进一步的长期研究来评估心脏异常（短暂或持续）是否与主要心脏事件相关。
