儿童多系统炎症综合征最新研究进展

Latest research progress on multisystem inflammatory syndrome in children

儿童多系统炎症综合征(MIS-C)于2020年4月由英国儿科医师首次报道,是一种与严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染相关、可引起多系统损害的疾病,其表现与其他儿童炎症综合征的临床特征有重叠,包括川崎病、中毒性休克综合征和巨噬细胞激活综合征等。MIS-C的发展与SARS-CoV-2感染密切相关,在大多数情况下,可以认为是继发于病毒感染后的异常免疫反应,类似于成人感染SARS-CoV-2数日后出现的症状。目前用于诊断MIS-C的标准很可能过于宽泛,这意味着或会纳入患有不同疾病的患儿。该病好发于较大年龄儿童,这与川崎病多见于5岁以下儿童有明显的不同。MIS-C主要表现为持续高热、明显的消化道症状、血流动力学不稳定、心肌炎及炎症指标升高等。由于MIS-C的发病机制尚未清楚,目前采用不同的治疗手段,虽尚无特异性的治疗方法,但整体预后良好。目前仍需要进行大量的研究来提高临床医师对MIS-C的认识水平,明确其对儿童健康的真正影响,并阐明最佳的诊断和治疗方法以及真正的预后。

Multisystem inflammatory syndrome in children(MIS-C),first reported by British pediatricians in April,2020,is a disease associated with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection and can cause multiple system damage,and its manifestations overlap with the clinical features of other childhood inflammatory syndromes,including Kawasaki disease,toxic shock syndrome and macrophage activation syndrome,etc.The development of MIS-C is closely related to SARS-CoV-2 infection.In most cases,it can be considered as abnormal immune response following viral infection,similar to the symptoms of adults infected with SARS-CoV-2 a few days later.Current diagnostic criteria for MIS-C might be too broad so that children with different diseases can be included.MIS-C often occurs in older children,which is obviously different from Kawasaki disease in children under 5 years old.The main clinical manifestations of MIS-C were continuous high fever,obvious digestive tract symptoms,hemodynamic instability,myocarditis and increased inflammatory indicators,etc.As the pathogenesis of MIS-C is not clear,there is no specific treatment.However,the overall prognosis is excellent.At present,a large quantity of studies are required to deepen the understanding of MIS-C,assess the exact effect on children’s health,explore the optimal diagnosis and treatment and accurately evaluate clinical prognosis.