Endothelial Dysfunction as a Component of Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome in Children With Shock
Endothelial Dysfunction as a Component of Severe Acute Respiratory Syndrome Coronavirus 2-Related Multisystem Inflammatory Syndrome in Children With Shock
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DOI：
10.1097/ccm.0000000000005093
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发表时间：
2021-11-01
影响因子：
8.8
通讯作者：
Oualha, Mehdi
中科院分区：
文献类型：
--
作者：
Borgel, Delphine;Chocron, Richard;Oualha, Mehdi
目的：儿童严重急性呼吸综合征冠状病毒2相关多系统炎症综合征常伴有休克；内皮受累可能是潜在的机制之一。我们试图描述休克儿童多系统炎症综合征期间的内皮功能障碍，然后评估内皮受累程度与休克严重程度之间的关系。设计：观察性研究。工作地点：某三级医院PICU。患者：根据疾病控制和预防中心的标准，18岁以下（n = 28）患有严重急性呼吸综合征冠状病毒2相关儿童多系统炎症综合征和休克的患者。干预措施:没有。测量和主要结果：内皮标志物水平与休克严重程度的相关性采用Spearman系数进行评估。年龄中位数（四分位数间距）为9岁（7.5-11.2岁）。16例患儿出现心源性和分布性休克，10例患儿仅出现心源性休克，2例患儿仅出现分布性休克。左室射血分数中位数、肌钙蛋白水平和乳酸水平分别为40%（35 ~ 45%）、261 ng/mL （131 ~ 390 ng/mL）和3.2 mmol/L （2 ~ 4.2 mmol/L）。25名儿童接受了抗肌力药物和/或血管加压药物治疗；血管活性和肌力评分中位数为8（5-28）。血浆血管生成素-2 （6,426 pg/mL [2,814-11,836 pg/mL]）、硒选择素（130,405 pg/mL [92,987-192,499 pg/mL]）、血管性血液病因子抗原（344%[288-378%]）、血管生成素-2/血管生成素-1比值（1.111[0.472-1.524]）水平升高，并与血管活性评分和肌力评分显著相关（r = 0.45, p = 0.016; r = 0.53, p = 0.04; r = 0.46, p = 0.013; r = 0.46, p = 0.012）。结论：内皮功能障碍与休克儿童严重急性呼吸综合征冠状病毒2相关多系统炎症综合征相关，可能是其潜在机制之一。
OBJECTIVES: Severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children is frequently associated with shock; endothelial involvement may be one of the underlying mechanisms. We sought to describe endothelial dysfunction during multisystem inflammatory syndrome in children with shock and then assess the relationship between the degree of endothelial involvement and the severity of shock. DESIGN: Observational study. SETTING: A PICU in a tertiary hospital. PATIENTS: Patients aged under 18 (n = 28) with severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children and shock, according to the Centers for Disease Control and Prevention criteria. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Correlations between endothelial marker levels and shock severity were assessed using Spearman coefficient. The median (interquartile range) age was 9 years (7.5-11.2 yr). Sixteen children presented with cardiogenic and distributive shock, 10 presented with cardiogenic shock only, and two presented with distributive shock only. The median left ventricular ejection fraction, troponin level, and lactate level were, respectively, 40% (35-45%), 261 ng/mL (131-390 ng/mL), and 3.2 mmol/L (2-4.2 mmol/L). Twenty-five children received inotropes and/or vasopressors; the median Vasoactive and Inotropic Score was 8 (5-28). Plasma levels of angiopoietin-2 (6,426 pg/mL [2,814-11,836 pg/mL]), sE-selectin (130,405 pg/mL [92,987-192,499 pg/mL]), von Willebrand factor antigen (344% [288-378%]), and the angiopoietin-2/angiopoietin-1 ratio (1.111 [0.472-1.524]) were elevated and significantly correlated with the Vasoactive and Inotropic Score (r = 0.45, p = 0.016; r = 0.53, p = 0.04; r = 0.46, p = 0.013; and r = 0.46, p = 0.012, respectively). CONCLUSIONS: Endothelial dysfunction is associated with severe acute respiratory syndrome coronavirus 2-related multisystem inflammatory syndrome in children with shock and may constitute one of the underlying mechanisms.