新型冠状病毒感染相关儿童多系统炎症综合征的临床特征及发生低血压的危险因素

Clinical characteristics and risk factors for hypotension in children with multisystem inflammatory syndrome related to SARS-CoV-2

目的总结新型冠状病毒感染相关儿童多系统炎症综合征(MIS-C)的临床特征,分析发生低血压的危险因素。方法单中心回顾性研究,以2023年1月至2023年3月在北京儿童医院急诊内科就诊并收入院、最终确诊为MIS-C的患儿为研究对象,总结其临床特征,根据血压分为低血压组和血压正常组,比较两组患儿的实验室指标,并分析发生低血压的危险因素。结果共纳入36例患儿,中位年龄3.1(2.3,5.8)岁,男22例(61.1%)。所有患儿在发病前1~9周均有明确的新型冠状病毒感染史。临床表现包括发热(100.0%),皮疹(94.4%),双侧结膜充血(88.8%),口唇干红或杨梅舌(100.0%),手足硬肿(61.1%),颈部淋巴结肿大(88.8%),22例(61.1%)存在腹泻、腹痛、呕吐等急性消化道症状,12例(33.3%)存在精神萎靡、嗜睡、头痛、抽搐等神经系统表现,出现咳嗽、咽痛、呼吸促等呼吸道症状患儿15例(41.6%)。所有患儿预后良好,无死亡病例。19例(52.8%)患儿出现低血压并需要血管活性药物维持血压,其中4例需呼吸支持,1例为有创呼吸支持,且该例患儿同时接受了连续肾脏替代治疗。低血压组患儿的血清铁蛋白水平显著高于血压正常组(P<0.05);而血小板计数、血清钠离子和钾离子水平则较血压正常组明显下降(P<0.05)。Logistic回归分析发现血清铁蛋白升高(OR=20.000,95%CI 2.750~145.481,P=0.003)是发生低血压的独立危险因素。结论新型冠状病毒感染相关MIS-C的临床表现多样且常合并多器官功能损伤,容易发生低血压。血清铁蛋白升高是发生低血压的独立危险因素。

Objective To summarize the clinical characteristics of multisystem inflammatory syndrome in children(MIS-C)related to SARS-CoV-2 and analyze the risk factors for hypotension.Methods The clinical data of children with MIS-C who visited Beijing Children's Hospital from January 2023 to March 2023 were retrospectively collected,and the clinical characteristics and risk factors for hypotension were analyzed.ResultsThirty-six patients were included,the median age was 3.1(2.3,5.8)years;61.1%were boys.All cases had a history of SARS-CoV-2 infection between 1 and 9 weeks before onset.Clinical symptoms included fever(100.0%);rash(94.4%);bilateral conjunctival congestion(88.8%);lips/oral cavity changes(100.0%);swollen hands and foot(61.1%);cervical lymphadenopathy(88.8%);acute gastrointestinal symptoms(61.1%)of diarrhea,abdominal pain and vomiting;neurologic manifestations(33.3%)of lethargy,headache,and convulsions;respiratory symptoms(41.6%)of cough,sore throat and shortness of breath.Nineteen(52.8%)cases developed hypotension and needed vasoactive drugs support to maintain blood pressure.Mechanical ventilation was required in four(11.1%)cases,and one patient was intubated and treated with continuous renal replacement therapy.The level of ferritin in hypotension group was significantly higher than those in normal blood pressure group(P<0.05),while the levels of platelet count,serum sodium and potassium in hypotension group were significantly lower than those in normal blood pressure group(P<0.05).Logistic regression multivariable analysis found the elevated serum ferritin(OR=20.000,95%CI:2.750-145.481,P=0.003)was an independent risk factor for hypotension.Conclusions MIS-C may be observed following SARS-CoV-2 infection.Various symptoms and signs,including fever,multiple organ dysfunction,and hypotension,may occur in children with MIS-C.Elevated ferritin is a risk factor for hypotension.