Multisystem Inflammatory Syndrome in Children in New York State
Multisystem Inflammatory Syndrome in Children in New York State
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DOI：
10.1056/nejmoa2021756
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发表时间：
2020-07-23
影响因子：
158.5
通讯作者：
Zucker, Howard
中科院分区：
文献类型：
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作者：
Dufort, Elizabeth M.;Koumans, Emilia H.;Zucker, Howard
儿童多系统炎症综合征与Covid-19有关。这篇来自纽约州的报告介绍了一项描述性分析，总结了99名符合纽约州卫生部对该综合征定义的儿科患者的临床表现、并发症和结果。儿童多系统炎症综合征（MIS-C）与2019冠状病毒病有关。纽约州卫生部（NYSDOH）在全州范围内建立了积极的监测，以描述患有该综合征的住院患者。方法纽约州各医院报告了21岁以下住院患者的川崎病、中毒性休克综合征、心肌炎和潜在的misc病例，并将病历发送给NYSDOH。我们进行了描述性分析，总结了2020年3月1日至5月10日期间符合NYSDOH misc病例定义的患者的临床表现、并发症和结局。结果截至2020年5月10日，NYSDOH共报告了191例潜在病例。确诊的95例（实验室确诊的急性或近期严重急性呼吸综合征冠状病毒2 [SARS-CoV-2]感染）和疑似的4例（符合临床和流行病学标准）中，男性53例（54%）；78人中有31人（40%）是黑人，85人中有31人（36%）是西班牙裔。0 ~ 5岁31例（31%），6 ~ 12岁42例（42%），13 ~ 20岁26例（26%）。均表现为主观发热或发冷；97%有心动过速，80%有胃肠道症状，60%有皮疹，56%有结膜注射，27%有粘膜改变。c反应蛋白、d-二聚体和肌钙蛋白水平分别在100%、91%和71%的患者中升高；62%接受了血管加压素支持，53%有心肌炎的证据，80%住进了重症监护病房，2人死亡。住院时间中位数为6天。结论纽约州儿童多系统炎症综合征的出现与SARS-CoV-2的广泛传播同时发生；这种伴有皮肤、粘膜和胃肠道症状的高炎症综合征与心功能障碍有关。
A multisystem inflammatory syndrome in children is associated with Covid-19. This report from New York State presents a descriptive analysis that summarizes the clinical presentation, complications, and outcomes of 99 pediatric patients meeting the New York State Department of Health definition of this syndrome.Background A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome. Methods Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020. Results As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein,d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days. Conclusions The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.