土耳其 101 例与 COVID-19 相关的儿童多系统炎症综合征（Turk-MISC 研究）。
Multisystem inflammatory syndrome in children associated with COVID-19 in 101 cases from Turkey (Turk-MISC study).
机构信息
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Katip Celebi University, Izmir, Turkey.
Department of Pediatric Infectious Diseases, Faculty of Medicine, Izmir Tepecik Training and Research Hospital, University of Health Sciences, Izmir, Turkey.
出版信息
J Paediatr Child Health. 2022 Jun;58(6):1069-1078. doi: 10.1111/jpc.15913. Epub 2022 Feb 24.
AIM
Multisystem inflammatory syndrome in children (MIS-C) may cause shock and even death in children. The aim of this study is to describe the clinical features, laboratory characteristics and outcome of children diagnosed with MIS-C in 25 different hospitals in Turkey.
METHODS
The retrospective study was conducted between 8 April and 28 October 2020 in 25 different hospitals from 17 cities. Data were collected from patients' medical records using a standardised form. Clinical and laboratory characteristics and outcomes according to different age groups, gender and body mass index percentiles were compared using multivariate logistic regression analysis.
RESULTS
The study comprised 101 patients, median age 7 years (interquartile range (IQR) 4.6-9.3); 51 (50.5%) were boys. Reverse-transcriptase polymerase chain reaction (PCR) assay was positive in 21/100 (21%) patients; 62/83 (74.6%) patients had positive serology for SARS-CoV-2. The predominant complaints were fever (100%), fatigue (n = 90, 89.1%), and gastrointestinal symptoms (n = 81, 80.2%). Serum C-reactive protein (in 101 patients, median 165 mg/L; range 112-228), erythrocyte sedimentation rate (73/84, median 53 mm/s; IQR 30-84) and procalcitonin levels (86/89, median 5 μg/L; IQR 0.58-20.2) were elevated. Thirty-eight patients (37.6%) required admission to intensive care. Kawasaki disease (KD) was diagnosed in 70 (69.3%) patients, 40 of whom had classical KD. Most patients were treated with intravenous immunoglobulin (n = 92, 91%) and glucocorticoids (n = 59, 58.4%). Seven patients (6.9%) died.
CONCLUSION
The clinical spectrum of MIS-C is broad, but clinicians should consider MIS-C in the differential diagnosis when persistent fever, fatigue and gastrointestinal symptoms are prominent. Most patients diagnosed with MIS-C were previously healthy. Immunomodulatory treatment and supportive intensive care are important in the management of cases with MIS-C. Glucocorticoids and intravenous immunoglobulins are the most common immunomodulatory treatment options for MIS-C. Prompt diagnosis and prompt treatment are essential for optimal management.
目的
儿童多系统炎症综合征（MIS-C）可导致儿童休克甚至死亡。本研究的目的是描述在土耳其 25 家不同医院诊断为 MIS-C 的患儿的临床特征、实验室特征和结局。
方法
本回顾性研究于 2020 年 4 月 8 日至 10 月 28 日在土耳其 17 个城市的 25 家不同医院进行。使用标准化表格从患者病历中收集数据。使用多变量逻辑回归分析比较不同年龄组、性别和体重指数百分位的临床和实验室特征及结局。
结果
本研究共纳入 101 例患儿，中位年龄 7 岁（四分位距 4.6-9.3）；51 例（50.5%）为男孩。21/100 例（21%）患儿逆转录酶聚合酶链反应（PCR）检测呈阳性；62/83 例（74.6%）患儿 SARS-CoV-2 血清学检测呈阳性。主要症状为发热（100%）、乏力（n=90，89.1%）和胃肠道症状（n=81，80.2%）。101 例患儿血清 C 反应蛋白（中位数 165mg/L；范围 112-228）、红细胞沉降率（73/84，中位数 53mm/s；四分位距 30-84）和降钙素原水平（86/89，中位数 5μg/L；四分位距 0.58-20.2）升高。38 例（37.6%）患儿需入住重症监护病房。70 例（69.3%）患儿诊断为川崎病（KD），其中 40 例为典型 KD。大多数患儿接受静脉免疫球蛋白（n=92，91%）和糖皮质激素（n=59，58.4%）治疗。7 例（6.9%）患儿死亡。
结论
MIS-C 的临床谱广泛，但当持续性发热、乏力和胃肠道症状突出时，临床医生应考虑 MIS-C 的鉴别诊断。大多数诊断为 MIS-C 的患儿既往健康。免疫调节治疗和支持性重症监护对 MIS-C 病例的管理很重要。糖皮质激素和静脉免疫球蛋白是 MIS-C 最常用的免疫调节治疗选择。及时诊断和及时治疗对于优化管理至关重要。
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