急性白血病儿童新型冠状病毒感染相关多系统炎症综合征临床特征

Clinical characteristics of acute leukemia children with multisystem inflammatory syndrome associated with SARS⁃CoV⁃2 infection

目的:探讨急性白血病患儿新型冠状病毒(SARS-CoV-2)感染相关多系统炎症综合征(MIS-C)的临床特点及治疗方法。方法:回顾性收集、分析武汉大学人民医院儿科收治的1例急性白血病合并MIS-C患儿临床资料,并检索相关文献。结果:武汉大学人民医院儿科1例急性早幼粒细胞白血病(APL)患儿感染SARS-CoV-2后合并MIS-C,以发热、皮疹、消化道症状和肝功能严重受损为主要表现,通过糖皮质激素治疗获得痊愈。共检索到6篇急性白血病合并MIS-C病例文献,主要表现为发热(n=6/6,100%)、消化道症状(n=4/6,66.6%)、心血管受损(n=3/6,50%)、皮疹(n=2/6,33.3%)、肾功能受损(n=1/6,16.6%);实验室检查提示D二聚体(D-Dimer)增高(n=6/6,100%)、C反应蛋白(CRP)增高(n=6/6,100%)、铁蛋白(SF)增高(n=6/6,100%)、细胞因子增高(n=2/6,33.3%);治疗上分别采用糖皮质激素、静脉用丙种球蛋白、化疗、阿那白滞素及抗凝治疗,所有病例均存活。结论:急性白血病并发MIS-C可以出现多系统损害,原发白血病、感染和炎症症状的重叠容易造成诊断的困难,需要提高认识。整体治疗效果好。

Objective:To investigate the clinical features and treatment of multiple system inflammatory syndrome(MIS⁃C)associated with SARS⁃CoV⁃2 in acute leukemia children.Methods:The clinical data of an acute leukemia child with MIS⁃C were collected and analyzed retrospectively,and the rele⁃vant literature was reviewed.Results:A case of acute promyelocytic leukemia(APL)complicated with MIS⁃C after infection with SARS⁃CoV⁃2.The main symptoms were fever,skin rash,digestive tract symptoms,and severe impairment of liver function.The patient was cured by glucocorticoid therapy.The literature of 6 cases of acute leukemia with MIS⁃C was retrieved.The main symptoms were fever(n=6/6,100%),digestive tract symptoms(n=4/6,66.6%),cardiovascular impairment(n=3/6,50%),skin rash(n=2/6,33.3%),and renal impairment(n=1/6,16.6%);Laboratory examination showed that D⁃dimer(n=6/6,100%),CRP(n=6/6,100%),SF(n=6/6,100%),and cytokines(n=2/6,33.3%)were increased.The patients were treated with glucocorticoid,IVIG,chemotherapy,anakinra,or anticoagulation,and all patients survived.Conclusion:MIS⁃C in acute leukemia patients can cause multi⁃system damage.The overlap of leukemia,infection and inflammation may cause diffi⁃culties in diagnosis.The overall response to treatment was good.