儿童川崎样多系统炎症综合征可能与SARS

添加时间:2020-06-08 浏览数:

本期文章:《英国医学杂志》:Online/在线发表

法国巴黎大学Martin Chalumeau团队分析了巴黎covid-19大流行期间儿童川崎样多系统炎症综合征的临床特征。2020年6月3日,该研究发表在《英国医学杂志》上。

为了描述受川崎样多系统炎性综合征暴发影响的儿童和青少年的特征,并评估其与SARS-CoV-2感染的潜在时间关联,研究组在法国巴黎的一家大学医院儿科进行了一项前瞻性观察研究。2020年4月27日至5月11日,共有21名具有川崎病特征的儿童和青少年(≤18岁)住院。主要结果包括临床和生物学数据、影像学和超声心动图发现、治疗和结局。所有患者均接受SARS-CoV-2检查。

短短15天内患川崎病的21名儿童和青少年的中位年龄为7.9岁,其中12例(57%)来自非洲。12例(57%)表现为川崎病休克综合征,16例(76%)表现为心肌炎。17例(81%)需要进行重症监护。所有21例患者在疾病早期都有明显的胃肠道症状,且炎症标记物水平很高。19例(90%)有近期SARS-CoV-2感染的证据。

21例患者均接受了静脉免疫球蛋白治疗,其中10例(48%)同时接受了皮质类固醇激素治疗。所有患者的临床预后均良好。在住院期间,有5名(24%)患者检测到中度冠状动脉扩张。到2020年5月15日,在平均住院8天后,所有患者均已出院。

研究组得出结论,巴黎地区儿童和青少年中持续发生的川崎样多系统性炎症综合征的爆发可能与SARS-CoV-2有关。且大多数患儿具有胃肠道症状和川崎病休克综合征,多数为非洲血统。

附:英文原文

Title: Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study

Author: Julie Toubiana, Clément Poirault, Alice Corsia, Fanny Bajolle, Jacques Fourgeaud, Franois Angoulvant, Agathe Debray, Romain Basmaci, Elodie Salvador, Sandra Biscardi, Pierre Frange, Martin Chalumeau, Jean-Laurent Casanova, Jérémie F Cohen, Slimane Allali

Issue&Volume: 2020/06/03

Abstract: Objectives To describe the characteristics of children and adolescents affected by an outbreak of Kawasaki-like multisystem inflammatory syndrome and to evaluate a potential temporal association with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Design Prospective observational study.

Setting General paediatric department of a university hospital in Paris, France.

Participants 21 children and adolescents (aged ≤18 years) with features of Kawasaki disease who were admitted to hospital between 27 April and 11 May 2020 and followed up until discharge by 15 May 2020.

Main outcome measures The primary outcomes were clinical and biological data, imaging and echocardiographic findings, treatment, and outcomes. Nasopharyngeal swabs were prospectively tested for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) and blood samples were tested for IgG antibodies to the virus.

Results 21 children and adolescents (median age 7.9 (range 3.7-16.6) years) were admitted with features of Kawasaki disease over a 15 day period, with 12 (57%) of African ancestry. 12 (57%) presented with Kawasaki disease shock syndrome and 16 (76%) with myocarditis. 17 (81%) required intensive care support. All 21 patients had noticeable gastrointestinal symptoms during the early stage of illness and high levels of inflammatory markers. 19 (90%) had evidence of recent SARS-CoV-2 infection (positive RT-PCR result in 8/21, positive IgG antibody detection in 19/21). All 21 patients received intravenous immunoglobulin and 10 (48%) also received corticosteroids. The clinical outcome was favourable in all patients. Moderate coronary artery dilations were detected in 5 (24%) of the patients during hospital stay. By 15 May 2020, after 8 (5-17) days of hospital stay, all patients were discharged home.

Conclusions The ongoing outbreak of Kawasaki-like multisystem inflammatory syndrome among children and adolescents in the Paris area might be related to SARS-CoV-2. In this study an unusually high proportion of the affected children and adolescents had gastrointestinal symptoms, Kawasaki disease shock syndrome, and were of African ancestry.

DOI: 10.1136/bmj.m2094

Source: https://www.bmj.com/content/369/bmj.m2094

期刊信息

BMJ-British Medical Journal:《英国医学杂志》,创刊于1840年。隶属于BMJ出版集团,最新IF:27.604
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投稿链接:https://mc.manuscriptcentral.com/bmj

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