Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study
Clinical features of severe pediatric patients with coronavirus disease 2019 in Wuhan: a single center's observational study
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DOI：
10.1007/s12519-020-00354-4
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发表时间：
2020-03-19
影响因子：
8.7
通讯作者：
Liu, Zhi-Sheng
中科院分区：
文献类型：
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作者：
Sun, Dan;Li, Hui;Liu, Zhi-Sheng
由SARS-CoV-2引起的2019冠状病毒病（COVID-19）疫情首次在中国湖北省武汉市发现。所有年龄段的人都容易感染SARS-CoV-2。目前尚未报告关于重症儿科COVID-19患者的信息。我们的目的是描述重症儿科COVID-19患者的临床特征。方法我们纳入了8例重症或危重症COVID-19患者，他们于1月24日至2月24日在武汉儿童医院重症监护室（ICU）接受治疗。我们收集了严重COVID-19患者的人口统计学数据、症状、影像学数据、实验室检查结果、治疗和临床结局等信息。结果8例患者发病年龄2个月~ 15岁，6例为男性。最常见的症状是呼吸急促（8/8），其次是发热（6/8）和咳嗽（6/8）。胸部影像学表现为多发斑片状阴影7例，磨玻璃样阴影6例。实验室检查结果显示全血细胞计数正常或升高（7/8），C反应蛋白、降钙素原和乳酸脱氢酶升高（6/8），肝功能异常（4/8）。其他表现包括CD 16 + CD 56（4/8）和Th/Ts*（1/8）降低，CD 3（2/8）、CD 4（4/8）和CD 8（1/8）升高，IL-6（2/8）、IL-10（5/8）和IFN-γ（2/8）升高。治疗方式集中在对症和呼吸支持。2例危重患者接受有创机械通气。截至2020年2月24日，3名患者仍在ICU接受治疗，其余5名患者已康复出院。结论武汉地区重症患儿以呼吸急促最常见，其次为发热和咳嗽。常见的影像学改变包括多发斑片状阴影和毛玻璃样阴影;在这些患者中发现了细胞因子风暴，这在危重患者中显得更严重。
Background An outbreak of coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was first detected in Wuhan, Hubei, China. People of all ages are susceptible to SARS-CoV-2 infection. No information on severe pediatric patients with COVID-19 has been reported. We aimed to describe the clinical features of severe pediatric patients with COVID-19. Methods We included eight severe or critically ill patients with COVID-19 who were treated at the Intensive Care Unit (ICU), Wuhan Children's Hospital from January 24 to February 24. We collected information including demographic data, symptoms, imaging data, laboratory findings, treatments and clinical outcomes of the patients with severe COVID-19. Results The onset age of the eight patients ranged from 2 months to 15 years; six were boys. The most common symptoms were polypnea (8/8), followed by fever (6/8) and cough (6/8). Chest imaging showed multiple patch-like shadows in seven patients and ground-glass opacity in six. Laboratory findings revealed normal or increased whole blood counts (7/8), increased C-reactive protein, procalcitonin and lactate dehydrogenase (6/8), and abnormal liver function (4/8). Other findings included decreased CD16 + CD56 (4/8) and Th/Ts*(1/8), increased CD3 (2/8), CD4 (4/8) and CD8 (1/8), IL-6 (2/8), IL-10 (5/8) and IFN-gamma (2/8). Treatment modalities were focused on symptomatic and respiratory support. Two critically ill patients underwent invasive mechanical ventilation. Up to February 24, 2020, three patients remained under treatment in ICU, the other five recovered and were discharged home. Conclusions In this series of severe pediatric patients in Wuhan, polypnea was the most common symptom, followed by fever and cough. Common imaging changes included multiple patch-like shadows and ground-glass opacity; and a cytokine storm was found in these patients, which appeared more serious in critically ill patients.