儿童炎症性多系统综合征与 SARS-CoV-2 相关（PIMS-TS）：巴西队列研究。
Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS): a Brazilian cohort.
机构信息
Pediatric Rheumatology Unit, Hospital das Clínicas da Universidade Federal de Pernambuco, Av. Prof. Moraes Rego, 1235 - Cidade Universitária, Recife, PE, CEP 50670-901, Brazil.
Pediatric Rheumatology Unit, Hospital da Criança de Brasília José Alencar, Brasília, DF, Brazil.
出版信息
Adv Rheumatol. 2022 Feb 21;62(1):6. doi: 10.1186/s42358-022-00237-4.
BACKGROUND
Paediatric inflammatory multisystem syndrome (PIMS) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been described since mid-April 2020 with the first reports coming from Europe. Our objective was to describe the characteristics of patients among the Brazilian population.
METHODS
A multicenter retrospective study was conducted with the participation of five pediatric rheumatology centers in Brazil during the period from March to November 2020. Children and adolescents with PIMS temporally associated with SARS-CoV-2 (TS) who met the definition criteria for the disease according to the Royal College of Paediatrics and Child Health were included. Demographic, clinical, laboratory, therapeutic characteristics and molecular and serological diagnosis of SARS-CoV-2 infection were described.
RESULTS
Fifty-seven children and adolescents with PIMS-TS were evaluated, 54% female, with a median age of 8 (3-11) years. Most (86%) were previously healthy, with asthma being the main comorbidity, present in 10% of the patients. Fever was the main manifestation, present in all patients, followed by mucocutaneous and gastrointestinal features, present in 89% and 81% of the patients, respectively. Myocarditis occurred in 21% of the patients and in 68% of them required intensive care. The Kawasaki disease phenotype occurred in most patients (77%). All patients had elevated inflammatory markers, with elevated CRP being the most found (98%). Anemia and lymphopenia were present in 79% and 72%, respectively. Laboratory evidence of SARS-CoV-2 was found in 77% of the patients, with 39% positive RT-PCR and 84% positive serology for SARS-CoV-2. An immunomodulatory treatment was performed in 91% of the patients, with 67% receiving intravenous immunoglobulin (IVIG) associated with glucocorticoid, 21% receiving IVIG, and 3.5% receiving glucocorticoid. The median length of hospitalization was 10 days.
CONCLUSIONS
This study showed a high morbidity of PIMS-TS in Brazilian children, with a prolonged length of hospitalization and a high rate of admission to pediatric intensive care unit. Multicenter prospective studies are needed to assess the morbidity of the disease in the medium and long term.
背景
自 2020 年 4 月中旬以来，已有关于与严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）相关的儿科炎症性多系统综合征（PIMS）的报道，第一批报告来自欧洲。我们的目的是描述巴西人群中患者的特征。
方法
这是一项多中心回顾性研究，参与了巴西的五家儿科风湿病中心，研究时间为 2020 年 3 月至 11 月。符合根据皇家儿科学会和儿童健康定义的疾病标准的、与 SARS-CoV-2（TS）时间相关的 PIMS 儿童和青少年被纳入研究。描述了人口统计学、临床、实验室、治疗特征以及 SARS-CoV-2 感染的分子和血清学诊断。
结果
共评估了 57 名 PIMS-TS 患儿，女性占 54%，中位年龄为 8（3-11）岁。大多数（86%）患儿既往健康，哮喘是主要的合并症，占患儿的 10%。发热是最主要的表现，所有患儿均有发热，其次是黏膜和胃肠道表现，分别占 89%和 81%。21%的患儿出现心肌炎，其中 68%需要重症监护。大多数患儿（77%）出现川崎病表型。所有患儿均有炎症标志物升高，其中 C 反应蛋白升高最常见（98%）。77%的患儿实验室证据表明存在 SARS-CoV-2，其中 39%的患儿 RT-PCR 阳性，84%的患儿 SARS-CoV-2 血清学阳性。91%的患儿接受了免疫调节治疗，其中 67%的患儿接受静脉注射免疫球蛋白（IVIG）联合糖皮质激素，21%的患儿接受 IVIG，3.5%的患儿接受糖皮质激素。中位住院时间为 10 天。
结论
本研究显示，巴西儿童的 PIMS-TS 发病率较高，住院时间较长，小儿重症监护病房入住率较高。需要进行多中心前瞻性研究，以评估该疾病的中长期发病率。
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