伊朗 COVID-19 感染后儿童多系统炎症综合征 (MIS-C) 的临床特征和结局：一项多中心研究。
Clinical characteristics and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 infection in Iran: A multicenter study.
机构信息
Pediatric Infectious Diseases Research Center, Communicable Diseases Institute, Mazandaran University of Medical Sciences, Sari, Iran.
Venizeleion General Hospital, Heraklion, Crete, Greece.
出版信息
PLoS One. 2022 Sep 22;17(9):e0274104. doi: 10.1371/journal.pone.0274104. eCollection 2022.
OBJECTIVES
This study aimed to assess the clinical characteristics, treatment and outcomes of the multisystem inflammatory syndrome in children (MIS-C) following COVID-19 in five different geographical regions of Iran.
METHODS
In this multicenter observational study, patients <21 years were included between March 2020 and October 2021. By Disease Control and Prevention (CDC) checklist, demographic characteristics, comorbidities, clinical signs and symptoms, laboratory and radiology findings, and treatment were collected. Statistical analysis was using Chi-square and t-test in STATA14.
RESULTS
In total 225 patients with median age of 55 (26-96) months were included that 59.56% boys. 57.33% were admitted to the PICU with a median of 7 days (4-10). 95.56% of patients were discharged with recovery and the rest died. All of the patients in our study were included based on the MIS-C criteria. However, some patients had Kawasaki symptoms, so we compared the clinical and epidemiological characteristics of the two groups. Conjunctival injection, cervical lymphadenopathy>1.5 cm diameter, and strawberry tongue in Kawasaki-like MIS-C patients were higher than of MIS-C patients, and this difference was significant(p<0.001). The most common comorbidity was obesity (24.86%). Most patients tested for COVID-19 and about 60% of the patients had a positive test by serology or reverse transcription-polymerase chain reaction (RT-PCR). Gastrointestinal (88.89%) and hematologic signs (84.44%) were most common. Most drugs used in patients were IVIG and steroids. 88.07% and 61.29% of the patients had at least one problem in echocardiography and lung CT, respectively.
CONCLUSIONS
The best outcome was seen in patients who were treated with both IVIG and steroids on the first days of admission. Myocarditis was common in two groups of patients. According to most patients had echocardiography abnormal, screening of heart function is recommended for patients.
目的
本研究旨在评估伊朗五个不同地区 COVID-19 后儿童多系统炎症综合征（MIS-C）的临床特征、治疗方法和结局。
方法
在这项多中心观察性研究中，纳入了 2020 年 3 月至 2021 年 10 月期间年龄小于 21 岁的患者。通过疾病控制和预防中心（CDC）检查表，收集了人口统计学特征、合并症、临床症状和体征、实验室和影像学发现以及治疗情况。统计分析采用 STATA14 中的卡方检验和 t 检验。
结果
共纳入 225 例中位年龄为 55（26-96）个月的患儿，其中 59.56%为男性，57.33%患儿入住儿科重症监护病房，中位住院时间为 7 天（4-10 天）。95.56%的患儿康复出院，其余患儿死亡。我们研究中的所有患者均符合 MIS-C 标准。然而，部分患儿存在川崎病症状，因此我们比较了两组患儿的临床和流行病学特征。川崎病样 MIS-C 患儿的结膜充血、颈淋巴结肿大>1.5cm 直径和草莓舌发生率高于 MIS-C 患儿，差异有统计学意义（p<0.001）。最常见的合并症是肥胖（24.86%）。大多数患儿进行了 COVID-19 检测，约 60%的患儿通过血清学或逆转录聚合酶链反应（RT-PCR）检测呈阳性。胃肠道（88.89%）和血液学表现（84.44%）最常见。患者最常使用的药物是 IVIG 和类固醇。88.07%和 61.29%的患者在超声心动图和肺部 CT 检查中至少有一个问题。
结论
在入院后第一天同时使用 IVIG 和类固醇治疗的患者中，结局最好。两组患儿均常见心肌炎。鉴于大多数患者存在超声心动图异常，建议对患儿进行心脏功能筛查。
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