成人 COVID-19 相关多系统炎症综合征（MIS-A）的新兴威胁：一项系统综述。
The emerging threat of multisystem inflammatory syndrome in adults (MIS-A) in COVID-19: A systematic review.
机构信息
Department of Cardiology, Govind Ballabh Pant Institute of Postgraduate Medical, Education and Research, Delhi, India.
Department of Pulmonary and Critical Care Medicine, Vardhman Mahavir Medical, College and Safdarjung Hospital, Delhi 110029, India.
出版信息
Heart Lung. 2022 Jul-Aug;54:7-18. doi: 10.1016/j.hrtlng.2022.03.007. Epub 2022 Mar 14.
BACKGROUND
The exact prevalence of Multisystem Inflammatory Syndrome in Adults (MIS-A) is largely unknown. Vague and multiple definitions and treatment options often add to the confusion on how to label the diagnosis with certainty.
OBJECTIVES
The objective of the study was to determine the demographic profile, clinical presentation, laboratory findings and outcomes of MIS-A in COVID-19.
METHODS
A systematic review was conducted after registering with PROSPERO. Multiple databases were systematically searched to encompass studies characterizing MIS-A from 1st January 2020 up to 31st August 2021. The inclusion criteria were- to incorporate all published or in press peer-reviewed articles reporting cases of MIS-A. We accepted the following types of studies: case reports, case-control, case series, cross-sectional studies and letters to the editors that incorporated clinical, laboratory, imaging, as well as the hospital course of MIS-A patients. The exclusion criteria for the review were- articles not in English, only abstracts published, no data on MIS-A and articles which have focus on COVID-19, and not MIS-A. Two independent authors screened the articles, extracted the data, and assessed the risk of bias.
RESULTS
A total of 53 articles were included in this review with a sample size of 79 cases. Majority of the patients were males (73.4%) with mean age of 31.67±10.02 years. Fever (100%) and skin rash (57.8%) were the two most common presenting symptoms. Echocardiographic data was available for 73 patients of whom 41 (73.2%) had reduced left ventricular ejection fraction. Cardiovascular system was most frequently involved (81%) followed by gastrointestinal (73.4%) and mucocutaneous (51.9%) involvement. Anti-inflammatory therapies used in treatment included steroids (60.2%), intravenous immunoglobulin (37.2%) and biologics (10.2%). Mean duration of the hospital stay was 11.67±8.08 days. Data regarding the outcomes was available for all 79 subjects of whom 4 (5.1%) died during course of hospital stay.
CONCLUSIONS
Emergence of MIS-A calls for further large-scale studies to establish standard case definitions and definite treatment guidelines.
背景
成人多系统炎症综合征（MIS-A）的确切患病率尚不清楚。模糊和多种定义以及治疗选择常常增加了如何明确诊断的混淆。
目的
本研究旨在确定 COVID-19 中 MIS-A 的人口统计学特征、临床表现、实验室检查结果和转归。
方法
在 PROSPERO 注册后进行了系统评价。系统搜索了多个数据库，以涵盖 2020 年 1 月 1 日至 2021 年 8 月 31 日期间描述 MIS-A 的所有已发表或即将发表的同行评议文章。纳入标准为：纳入所有报告 MIS-A 病例的已发表或即将发表的同行评议文章。我们接受了以下类型的研究：病例报告、病例对照、病例系列、横断面研究和纳入 MIS-A 患者临床、实验室、影像学和住院过程的给编辑的信件。该综述的排除标准为：非英文文章、仅发表摘要、无 MIS-A 数据和以 COVID-19 为重点且非 MIS-A 的文章。两名独立作者筛选文章、提取数据并评估偏倚风险。
结果
本综述共纳入 53 篇文章，样本量为 79 例。大多数患者为男性（73.4%），平均年龄为 31.67±10.02 岁。发热（100%）和皮疹（57.8%）是最常见的两种首发症状。有 73 例患者提供了超声心动图数据，其中 41 例（73.2%）左心室射血分数降低。心血管系统受累最常见（81%），其次是胃肠道（73.4%）和黏膜皮肤（51.9%）受累。治疗中使用的抗炎治疗包括皮质类固醇（60.2%）、静脉注射免疫球蛋白（37.2%）和生物制剂（10.2%）。平均住院时间为 11.67±8.08 天。所有 79 例患者均有结局数据，住院期间有 4 例（5.1%）死亡。
结论
MIS-A 的出现需要进一步进行大规模研究，以建立标准的病例定义和明确的治疗指南。
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