Ann Rheum Dis:类似于川崎病,与SARS-CoV-2相关的儿童多系统炎性综合征(Kawa-COVID-19)

2020-06-13 xiangting MedSci原创

Kawa-COVID-19可能代表了一种时间上与SARS-CoV-2感染相关的新型全身性炎症综合征。

目前的数据表明,儿童COVID-19的患病率低,病程较轻。但是过去几周内,来大巴黎地区医院就诊表型类似于川崎病(KD)的儿童人数有所增加,这使得法国国家卫生当局发出了警报。

5月3日左右开始有相关报道:英意法儿童出现罕见综合征,类似川崎病Lancet:新冠肺炎疫情期间需警惕儿童川崎病风险

对2020年4月以来巴黎地区与检测到严重急性呼吸器官综合征冠状病毒2(SARS-CoV-2)相关的KD患者进行了多中心编辑(Kawa-COVID-19)。将一个“经典”KD历史队列作为对照。

纳入16例患者(性别比=1,中位年龄10岁,IQR(4.7-12.5))。11例患者检出了SARS-CoV-2(69%),而另外5例患者则证明最近与定量PCR阳性个体有接触(31%)。心脏受累包括44%的患者出现心肌炎(n=7)。进展为严重疾病的预测因素(即需要重症监护,n=7)是年龄超过5岁和铁蛋白血症>1400µg/L。只有5例患者(31%)静脉输注免疫球蛋白(IVIg)治疗成功,而10例患者(62%)需要二线治疗。Kawa-COVID-19队列与“经典” KD对照组的区别是发病年龄较大(10岁vs 2岁(p<0.0001)),血小板计数较低(188 vs 383G/L(p<0.0001)),心肌炎发病率较高(7/16 vs 3/220(p=0.001))和首次IVIg治疗耐药(10/16 vs 45/220 (p=0.004))。

Kawa-COVID-19可能代表了一种时间上与SARS-CoV-2感染相关的新型全身性炎症综合征。为了确认这些发现并更好地了解Kawa-COVID-19的病理生理,有必要进行进一步的前瞻性国际研究。

原始出处:

Marie Pouletty. Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 mimicking Kawasaki disease (Kawa-COVID-19): a multicentre cohort. Ann Rheum Dis. 11 June 2020.

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    2021-02-12 hukaixun
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    2020-06-15 小刀医生
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    2020-06-13 lovetcm

    #川崎病#通过最近的一系列的研究的发表,对这个疾病认知越来越清晰了,就是非常好的事情。

    0

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拓展阅读

川崎病患者急性前壁心梗冠脉内瑞替普酶溶栓

患者男性,26岁,胸痛7小时入院。凌晨急诊转入,心电图显示为急性前壁心肌梗死。

ADC:新西兰川崎病发病率趋势研究

研究描述新西兰KD的发病率、季节变化、长期结局和死亡率。

38例川崎病合并颈深间隙受累患儿临床特征及危险因素分析

本研究对深圳市儿童医院KD合并DNSI患儿的临床资料进行总结,分析KD患儿合并DNSI的危险因素,旨在提高临床对此类少见KD并发症的识别能力和诊疗能力。

Nat Cardiovasc Res 张玉霞/顾晓琼/吴玉章合作揭示NO信号通过MCM8介导的线粒体自噬维持心血管功能的新机制

该研究发现染色体维持复合体8蛋白的表达在并发冠状动脉瘤的川崎病患儿中显著下降。

JOP:年龄较大和年龄较小川崎病患儿临床特征的差异

研究调查了年龄较大和年龄较小川崎病儿童临床特征的差异。

A&R:mTOR 抑制可防止川崎病小鼠模型中的冠状动脉重塑

该研究结果表明,在相关的KD临床前模型中的冠状动脉重塑与mTOR信号传导相关,并对 mTOR 抑制敏感。这些发现说明mTOR 抑制剂(如雷帕霉素)用于治疗高危 KD 患者的临床潜力。