Department of Pediatrics, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy.
Microbiology Unit, Istituto di Ricovero e Cura a Carattere Scientifico St. Orsola Polyclinic, University of Bologna, 40138 Bologna, Italy.
Viruses. 2021 Oct 7;13(10):2022. doi: 10.3390/v13102022.
SARS-CoV-2 infection in children can trigger cardiovascular manifestations potentially requiring an intensive treatment and defining a new entity named Multisystem Inflammatory Syndrome in Children (MIS-C), whose features partially overlap with Kawasaki Disease (KD). A cross-sectional study including all diagnoses of MIS-C and KD from April 2020 to May 2021 in our metropolitan area was conducted evaluating clinical, laboratory (including immunological response, cytokines, and markers of myocardial damage), and cardiac (coronary and non-coronary) features at onset of the diseases. Evolution of ventricular dysfunction, valve regurgitations, and coronary lesions was documented. The severity of the disease was also considered based on the need for inotropic support and ICU admission. Twenty-four MIS-C were diagnosed (14 boys, median age 82 months): 13/24 cases (54.17%) presented left ventricular dysfunction, 12/24 (50%) required inotropic support, and 10/24 (41.67%) developed coronary anomalies (CALs). All patients received steroids and IVIG at a median time of 5 days (IQR1:4, IQR3:6.5) from onset of fever and heart function normalized 6 days (IQR1: 5, IQR3: 7) after therapy, while CALs persisted in one. One patient (12.5%) required infliximab because of refractory disease and still presented CALs 18 days after therapy. During the same study period, 15 KD were diagnosed: none had ventricular dysfunction, while 7/15 (46.67%) developed CALs. Three out of 15 patients (20%) still presented CALs 46 days from onset. Compared to KD, MIS-C pts have significantly higher IL8 and similar lymphocytes subpopulations. Despite a more severe presentation and initial cardiac findings compared to KD, the myocardial injury in MIS-C has a rapid response to immunomodulatory treatment (median time 6 days), in terms of ventricular function, valve regurgitations, and troponin. Incidence of CALs is similar at onset, but it tends to regress in most of the cases of MIS-C differently than in KD where CALs persist in up to 40% in the subacute stage after treatment.
SARS-CoV-2 感染儿童可引发心血管表现，可能需要重症治疗，并定义一种新的实体，即儿童多系统炎症综合征（MIS-C），其特征部分与川崎病（KD）重叠。对 2020 年 4 月至 2021 年 5 月在我们大都市地区的所有 MIS-C 和 KD 诊断进行了一项横断面研究，评估疾病发作时的临床、实验室（包括免疫反应、细胞因子和心肌损伤标志物）和心脏（冠状动脉和非冠状动脉）特征。记录了心室功能障碍、瓣膜反流和冠状动脉病变的演变。还根据是否需要正性肌力支持和 ICU 入院来评估疾病的严重程度。共诊断出 24 例 MIS-C（男 14 例，中位年龄 82 个月）：13/24 例（54.17%）存在左心室功能障碍，12/24 例（50%）需要正性肌力支持，10/24 例（41.67%）发生冠状动脉异常（CALs）。所有患者在发热开始后中位 5 天（IQR1：4，IQR3：6.5）接受类固醇和 IVIG 治疗，心脏功能在治疗后 6 天（IQR1：5，IQR3：7）恢复正常，而 1 例患者（12.5%）因疾病难治性接受英夫利昔单抗治疗，治疗后 18 天仍存在 CALs。在同一研究期间，诊断出 15 例 KD：无一例存在心室功能障碍，而 7/15 例（46.67%）发生 CALs。15 例患者中有 3 例（20%）在发病后 46 天仍存在 CALs。与 KD 相比，MIS-C 患者的 IL8 显著升高，淋巴细胞亚群相似。尽管与 KD 相比，MIS-C 患者的表现更为严重，初始心脏检查结果更为严重，但免疫调节治疗对心肌损伤的反应迅速（中位时间为 6 天），表现在心室功能、瓣膜反流和肌钙蛋白方面。CALs 的发生率在发病时相似，但在 MIS-C 中，CALs 在大多数情况下趋于消退，而在 KD 中，CALs 在治疗后亚急性期仍持续存在，高达 40%。
