新型冠状病毒感染后儿童多系统炎症综合征15例临床分析

Clinical analysis of 15 children with multisystem inflammatory syndrome after novel coronavirus infection

目的总结新型冠状病毒感染(COVID-19)后儿童多系统炎症综合征(MIS-C)的临床特点、诊治经验。方法回顾性分析2022年12月1日至2023年1月31日首都儿科研究所附属儿童医院心血管内科住院确诊的15例MIS-C患儿的临床资料。根据患儿是否合并休克分为休克组(n=6)和无休克组(n=9),比较两组间一般情况、治疗前辅助检查的差异。结果15例患儿,男12例,女3例,平均年龄(3.28±2.48)岁(9个月~7.9岁);COVID-19至发病的时间为(30.60±9.91)d。1例(7%)患儿接种新型冠状病毒疫苗。15例患儿均有发热、淋巴结肿大、口唇皲裂及杨梅舌。与无休克组患儿相比,休克组患儿年龄较大,血小板水平明显下降;降钙素原、白细胞介素-10、N末端前脑钠肽及铁蛋白明显升高;左室射血分数、左室短轴缩短率明显下降;左室收缩末径Z值明显升高,差异均有统计学意义(P均<0.05)。15例患儿均经过人免疫球蛋白治疗,其中5例合并重症心肌炎及休克患儿予甲泼尼龙冲击治疗5 d后序贯减量,6例休克患儿休克纠正时间为(5.14±2.12)d。15例患儿平均住院时间(11.00±4.80)d。随访半年,15例患儿均恢复良好,无后遗症。结论MIS-C患儿多发生于COVID-19后3~6周,男童多于女童,年长儿易合并休克,关注N末端前脑钠肽、心功能指标可早期识别休克。同时合并休克及重症心肌炎患儿使用大剂量甲泼尼龙冲击治疗有效,预后良好。

Objective To summarize the clinical features,diagnosis and treatment of multisystem inflammatory syndrome in children(MIS-C)after novel coronavirus infection(COVID-19),so as to improve the early recognition of MIS-C.Methods The general information,clinical manifestations,treatment and length of hospital stay of fifteen children diagnosed with MIS-C and hospitalized in the Department of Cardiology,Children's Hospital,Capital Institute of Pediatrics from December 1,2022 to January 31,2023 were retrospectively analyzed.Fifteen children were divided into shock group(n=6)and non-shock group(n=9)according to the criteria of shock,and the differences in general conditions and laboratory examinations before treatment were compared between two groups.Results The mean age of fifteen children were(3.28±2.48)years(ranging from 9 months to 7.9 years),with a male to female ratio of 4:1.The mean time interval from COVID-19 to the onset of MIS-C was(30.60±9.91)days.The novel coronavirus vaccination rate was 7%.Fever,enlarged lymph nodes,cracked lips and a strawberry tongue were present in all children,with just one exhibiting peeling of the hands and feet.Compared with the non-shock group,patients in the shock group were older,the level of platelet decreased significantly,the level of procalcitonin,interleukin-10,N-terminal pro-brain natriuretic peptide(NT-proBNP)and ferritin significantly increased,the left ventricular ejection fraction and left ventricular fractional shortening decreased significantly,and the Z score of left ventricular end-systolic diameter significantly increased,and there were significant differences between two groups(P<0.05).All 15 patients were treated with human intravenous immunoglobulin,and five patients with severe myocarditis and shock accepted combined high-dose methylprednisolone pulse therapy over a period of five days,with the doses gradually tapering off afterwards.The mean hospital stay of all patients was(11.00±4.80)days,while the mean shock correction time of six patients was(5.14±2.12)days.After six months of follow-up,15 patients showed excellent prognosis with coronary lesions recovered and without any new complications.Conclusion Generally,MIS-C tends to occur 3-6 weeks after COVID-19,with more boys than girls.Older ones are more likely to suffer from shock.Focusing on NT-proBNP and cardiac function indicators could identify shock early.High-dose methylprednisolone pulse therapy may be effective and benefit for prognosis improvement in children complicated with both shock and severe myocarditis.