英国伦敦帝国理工学院Michael Levin团队分析了58例与SARS-CoV-2有关的小儿炎症性多系统综合症患儿的临床特征。2020年6月8日，该成果发表在《美国医学会杂志》上。

在2019冠状病毒病发病率较高的社区，出现了儿童患有发烧和炎症异常综合征的报告。

为了描述与SARS-CoV-2相关的小儿炎症性多系统综合征（PIMS-TS）住院患儿的临床和实验室特征，并将这些特征与其他儿童炎症性疾病进行比较，2020年3月23日至5月16日，研究组在英国8所医院招募了58名入院患儿，均持续发烧，炎症实验室证据符合PIMS-TS的定义。通过病例审查，分析临床和实验室特征，并与2002-2019年曾在欧洲和美国住院的川崎病（1132例）、川崎病休克综合征（45例）和中毒性休克综合征（37例）患儿的临床特征进行比较。

58名符合PIMS-TS标准的儿童中位年龄为9岁，女孩占57％。58例患儿中有15例（26％）SARS-CoV-2聚合酶链反应检测结果呈阳性，46例患儿中有40例（87％）SARS-CoV-2 IgG检测结果呈阳性。 总之，78%的患儿此时或曾经感染过SARS-CoV-2。所有患儿均出现发烧和非特异性症状，包括呕吐（45％）、腹痛（53％）和腹泻（52％）。有30例（52％）患儿出现皮疹，26例（45％）出现结膜充血。

实验室结果符合明显的炎症反应，例如，C反应蛋白为229 mg/L，铁蛋白为610 μg/L。在58名患儿中，有29名进展为休克，需要正性肌力支持和液体复苏（包括23名接受机械通气 ）；13名符合美国心脏协会对川崎病的定义，23名发烧和发炎，没有休克或川崎病征象。8名患儿（14％）发生了冠状动脉扩张或动脉瘤。PIMS-TS患儿的中位年龄为9岁，显著大于川崎病患儿（2.7岁）和川崎病休克综合征患儿（3.8岁）；PIMS-TS患儿的炎症标记物C反应蛋白水平为229 mg/L，显著高于川崎病患儿（67 mg/L）和川崎病休克综合征患儿（193 mg/L）。

总之，符合PIMS-TS标准的住院儿童其症状和疾病严重程度范围很广，从发烧和炎症到进展为心肌损伤、休克和冠状动脉瘤不等。

附：英文原文

Title: Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2

Author: Elizabeth Whittaker, Alasdair Bamford, Julia Kenny, Myrsini Kaforou, Christine E. Jones, Priyen Shah, Padmanabhan Ramnarayan, Alain Fraisse, Owen Miller, Patrick Davies, Filip Kucera, Joe Brierley, Marilyn McDougall, Michael Carter, Adriana Tremoulet, Chisato Shimizu, Jethro Herberg, Jane C. Burns, Hermione Lyall, Michael Levin

Issue&Volume: 2020-06-08

Abstract: Importance  In communities with high rates of coronavirus disease 2019, reports have emerged of children with an unusual syndrome of fever and inflammation.

Objectives  To describe the clinical and laboratory characteristics of hospitalized children who met criteria for the pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) and compare these characteristics with other pediatric inflammatory disorders.

Design, Setting, and Participants  Case series of 58 children from 8 hospitals in England admitted between March 23 and May 16, 2020, with persistent fever and laboratory evidence of inflammation meeting published definitions for PIMS-TS. The final date of follow-up was May 22, 2020. Clinical and laboratory characteristics were abstracted by medical record review, and were compared with clinical characteristics of patients with Kawasaki disease (KD) (n=1132), KD shock syndrome (n=45), and toxic shock syndrome (n=37) who had been admitted to hospitals in Europe and the US from 2002 to 2019.

Exposures  Signs and symptoms and laboratory and imaging findings of children who met definitional criteria for PIMS-TS from the UK, the US, and World Health Organization.

Main Outcomes and Measures  Clinical, laboratory, and imaging characteristics of children meeting definitional criteria for PIMS-TS, and comparison with the characteristics of other pediatric inflammatory disorders.

Results  Fifty-eight children (median age, 9 years [interquartile range {IQR}, 5.7-14]; 33 girls [57%]) were identified who met the criteria for PIMS-TS. Results from SARS-CoV-2 polymerase chain reaction tests were positive in 15 of 58 patients (26%) and SARS-CoV-2 IgG test results were positive in 40 of 46 (87%). In total, 45 of 58 patients (78%) had evidence of current or prior SARS-CoV-2 infection. All children presented with fever and nonspecific symptoms, including vomiting (26/58 [45%]), abdominal pain (31/58 [53%]), and diarrhea (30/58 [52%]). Rash was present in 30 of 58 (52%), and conjunctival injection in 26 of 58 (45%) cases. Laboratory evaluation was consistent with marked inflammation, for example, C-reactive protein (229 mg/L [IQR, 156-338], assessed in 58 of 58) and ferritin (610 μg/L [IQR, 359-1280], assessed in 53 of 58). Of the 58 children, 29 developed shock (with biochemical evidence of myocardial dysfunction) and required inotropic support and fluid resuscitation (including 23/29 [79%] who received mechanical ventilation); 13 met the American Heart Association definition of KD, and 23 had fever and inflammation without features of shock or KD. Eight patients (14%) developed coronary artery dilatation or aneurysm. Comparison of PIMS-TS with KD and with KD shock syndrome showed differences in clinical and laboratory features, including older age (median age, 9 years [IQR, 5.7-14] vs 2.7 years [IQR, 1.4-4.7] and 3.8 years [IQR, 0.2-18], respectively), and greater elevation of inflammatory markers such as C-reactive protein (median, 229 mg/L [IQR 156-338] vs 67 mg/L [IQR, 40-150 mg/L] and 193 mg/L [IQR, 83-237], respectively).

Conclusions and Relevance  In this case series of hospitalized children who met criteria for PIMS-TS, there was a wide spectrum of presenting signs and symptoms and disease severity, ranging from fever and inflammation to myocardial injury, shock, and development of coronary artery aneurysms. The comparison with patients with KD and KD shock syndrome provides insights into this syndrome, and suggests this disorder differs from other pediatric inflammatory entities.

DOI: 10.1001/jama.2020.10369

Source: https://jamanetwork.com/journals/jama/fullarticle/2767209