新冠病毒病和多系统炎症综合征患儿的肝脏受累情况：一项保加利亚单中心观察性研究
Liver Involvement in Children with COVID-19 and Multisystem Inflammatory Syndrome: A Single-Center Bulgarian Observational Study.
作者信息
Lazova Snezhina, Alexandrova Tea, Gorelyova-Stefanova Nadzhie, Atanasov Kalin, Tzotcheva Iren, Velikova Tsvetelina
机构信息
Pediatric Department, University Hospital "N. I. Pirogov", General Eduard I. Totleben Blvd. No. 21, 1606 Sofia, Bulgaria.
Health Care Department, Faculty of Public Health, Medical University Sofia, Bialo More, 8 Str., 1527 Sofia, Bulgaria.
出版信息
Microorganisms. 2021 Sep 15;9(9):1958. doi: 10.3390/microorganisms9091958.
SARS-CoV-2 infection may precede and cause various autoimmune and inflammatory diseases, including multisystem inflammatory syndrome in children (MIS-C). Therefore, we aimed to observe the clinical presentation and laboratory, instrumental and other constellations in children with MIS-C, including liver involvement. We present the outcomes from a single-center prospective observational study in which 89 children was included (60 with proven COVID-19, 10 symptomatic with confirmed COVID-19 contact and 19 diagnosed with MIS-C). Laboratory, instrumental, immunological, and clinical investigations were performed. Only 12% ( = 4) from the COVID-19 group (except the ICU cases), we found elevated AST and/or ALT (up to 100). All of the children with elevated transaminase were overweight or obese, presenting along with moderate COVID-19 pneumonia. The majority of children with MIS-C showed typical laboratory constellations with higher levels of IL-6 (120.36 ± 35.56 ng/mL). About half of the children in the MIS-C group (52%, = 11) showed elevated transaminases. Eleven children (57.9%) presented with abdominal pain, eight (42.1%) with ascites, two (10.5%) with hepatosplenomegaly, and four (21.1%) with symptoms such as diarrhea. Mesenteric lymphadenitis was observed more often in patients with elevated LDH (327.83 ± 159.39, = 0.077). Ascites was associated with lymphopenia (0.86 ± 0.80, = 0.029) and elevated LDH. Hepato-splenomegaly was also more frequent in children with lymphopenia (0.5 ± 0.14, = 0.039), higher troponin (402.00 ± 101.23, = 0.004) and low ESR. Diarrhea was more frequent in patients with lower CRP (9.00 ± 3.44 vs. 22.25 ± 2.58, = 0.04), and higher AST and ALT (469.00 ± 349.59 vs. and 286.67 ± 174.91, respectively, = 0.010), and D-dimer (4516.66 ± 715.83, = 0.001). Our data suggest that the liver can also be involved in MIS-C, presenting with typical laboratory and instrumental outcomes.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染可能先于并引发各种自身免疫性和炎性疾病，包括儿童多系统炎症综合征（MIS-C）。因此，我们旨在观察MIS-C患儿的临床表现、实验室检查、影像学检查及其他相关情况，包括肝脏受累情况。我们展示了一项单中心前瞻性观察性研究的结果，该研究纳入了89名儿童（60名确诊为新冠病毒病，10名有新冠病毒病确诊接触史且有症状，19名诊断为MIS-C）。进行了实验室、影像学、免疫学和临床检查。在新冠病毒病组（不包括重症监护病房病例）中，我们仅发现12%（n = 4）的患者谷草转氨酶（AST）和/或谷丙转氨酶（ALT）升高（最高达100）。所有转氨酶升高的儿童均超重或肥胖，同时伴有中度新冠病毒病肺炎。大多数MIS-C患儿表现出典型的实验室检查结果，白细胞介素-6（IL-6）水平较高（120.36±35.56纳克/毫升）。MIS-C组约一半的儿童（52%，n = 11）转氨酶升高。11名儿童（57.9%）出现腹痛，8名（42.1%）出现腹水，2名（10.5%）出现肝脾肿大，4名（21.1%）出现腹泻等症状。乳酸脱氢酶（LDH）升高的患者更常出现肠系膜淋巴结炎（327.83±159.39，P = 0.077）。腹水与淋巴细胞减少（0.86±0.80，P = 0.029）和LDH升高有关。淋巴细胞减少的儿童（0.5±0.14，P = 0.039）、肌钙蛋白水平较高（402.00±101.23，P = 0.004）和血沉较低的儿童肝脾肿大也更常见。腹泻在C反应蛋白（CRP）较低（9.00±3.44对22.25±2.58，P = 0.04）、AST和ALT较高（分别为469.00±349.59对286.67±174.91，P = 0.010）以及D-二聚体较高（4516.66±715.83，P = 0.001）的患者中更常见。我们的数据表明，肝脏也可受累于MIS-C，表现出典型的实验室和影像学检查结果。
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