新型冠状病毒感染流行背景下的儿童多系统炎症综合征

doi:10.7499/j.issn.1008-8830.2306093

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摘要儿童多系统炎症综合征（multisystem inflammatory syndrome in children, MIS-C）是在严重急性呼吸综合征冠状病毒-2（severe acute respiratory syndrome coronavirus 2, SARS-CoV-2）暴发流行的背景下出现的一种多系统受累综合征。MIS-C的临床表现与川崎病类似，但以发热及胃肠道症状为主要表现，严重者可出现中毒性休克和心功能不全。流行病学调查结果表明，大多数MIS-C患儿SARS-CoV-2抗体检测呈阳性。关于MIS-C的发病机制及病理生理过程尚不明确，SARS-CoV-2感染后的免疫失调被认为是主要原因。目前对于MIS-C的治疗以免疫球蛋白及对症支持治疗为主。该文对MIS-C的定义、流行病学、发病机制、临床表现、诊断、治疗及预后等进行了综述。

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	周彬
	黄育坤
	洪少贤
	焦富勇
	谢凯生

关键词 ：儿童多系统炎症综合征, 新型冠状病毒感染, 严重急性呼吸综合征冠状病毒2, 儿童

Abstract：Multisystem inflammatory syndrome in children (MIS-C) is a complex syndrome characterized by multi-organ involvement that has emerged in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak. The clinical presentation of MIS-C is similar to Kawasaki disease but predominantly presents with fever and gastrointestinal symptoms, and severe cases can involve toxic shock and cardiac dysfunction. Epidemiological findings indicate that the majority of MIS-C patients test positive for SARS-CoV-2 antibodies. The pathogenesis and pathophysiology of MIS-C remain unclear, though immune dysregulation following SARS-CoV-2 infection is considered a major contributing factor. Current treatment approaches for MIS-C primarily involve intravenous immunoglobulin therapy and symptomatic supportive care. This review article provides a comprehensive overview of the definition, epidemiology, pathogenesis, clinical presentation, diagnosis, treatment, and prognosis of MIS-C.

Key words： Multisystem inflammatory syndrome in children Coronavirus disease 2019 Severe acute respiratory syndrome coronavirus 2 Child

收稿日期: 2023-06-19

基金资助:福建省临床重点专科建设项目（XE2023-ZZYX-C01）。

通讯作者: 谢凯生，男，教授。Email：kshsieh@hotmail.com。 E-mail: kshsieh@hotmail.com

作者简介: 周彬，女，硕士研究生，住院医师；

引用本文:

周彬,黄育坤,洪少贤等. 新型冠状病毒感染流行背景下的儿童多系统炎症综合征[J]. 中国当代儿科杂志, 2024, 26(1): 98-102.

ZHOU Bin,HUANG Yu-Kun,HONG Shao-Xian et al. Multisystem inflammatory syndrome in children in the context of coronavirus disease 2019 pandemic[J]. CJCP, 2024, 26(1): 98-102.

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	1 World Health Organization. WHO coronavirus (COVID-19) dashboard[EB/OL]. [2022-11-07]. https://covid19.who.int/.
	CDC COVID-19 Response Team. Coronavirus disease 2019 in children: United States, February 12–April 2, 2020[J]. MMWR Morb Mortal Wkly Rep, 2020, 69(14): 422-426. PMID: 32271728. PMCID: PMC7147903. DOI: 10.15585/mmwr.mm6914e4.
	Sperotto F, Friedman KG, Son MBF, et al. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach[J]. Eur J Pediatr, 2021, 180(2): 307-322. PMID: 32803422. PMCID: PMC7429125. DOI: 10.1007/s00431-020-03766-6.
	4 Paediatric Intensive Care Society. PICS statement: increased number of reported cases of novel presentation of multisystem inflammatory disease[EB/OL]. (2020-04-27)[2022-11-07]. https://pccsociety.uk/wp-content/uploads/2020/04/PICS-statement-re-novel-KD-C19-presentation-v2-27042020.pdf.
	Riphagen S, Gomez X, Gonzalez-Martinez C, et al. Hyperinflammatory shock in children during COVID-19 pandemic[J]. Lancet, 2020, 395(10237): 1607-1608. PMID: 32386565. PMCID: PMC7204765. DOI: 10.1016/S0140-6736(20)31094-1.
	6 New York State Department of Health. Childhood inflammatory disease related to COVID-19[EB/OL]. [2023-03-24]. https://coronavirus.health.ny.gov/system/files/documents/2023/03/2023_advisory_mis-c_updated_case_definition.pdf.
	Zou H, Lu J, Liu J, et al. Characteristics of pediatric multi-system inflammatory syndrome (PMIS) associated with COVID-19: a meta-analysis and insights into pathogenesis[J]. Int J Infect Dis, 2021, 102: 319-326. PMID: 33202218. PMCID: PMC7666570. DOI: 10.1016/j.ijid.2020.11.145.
	Dufort EM, Koumans EH, Chow EJ, et al. Multisystem inflammatory syndrome in children in New York State[J]. N Engl J Med, 2020, 383(4): 347-358. PMID: 32598830. PMCID: PMC7346766. DOI: 10.1056/NEJMoa2021756.
	9 Royal College of Paediatrics and Child Health. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS): guidance for clinicians[EB/OL]. (2020-05-01)[2020-05-27]. https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance.
	10 CDC Health Alert Network. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19)[EB/OL]. (2020-05-14)[2020-05-19]. https://emergency.cdc.gov/han/2020/han00432.asp.
	11 World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19[EB/OL]. (2020-05-15)[2020-05-20]. https://apps.who.int/iris/bitstream/handle/10665/332095/WHO-2019-nCoV-Sci_Brief-Multisystem_Syndrome_Children-2020.1-eng.pdf.
	12 National Center for Immunization and Respiratory Diseases (U.S.). Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States[EB/OL]. [2021-11-07]. https://stacks.cdc.gov/view/cdc/104682.
	Han?erli T?rün S, Yilmaz ?iftdo?an D, Kara A. Multisystem inflammatory syndrome in children[J]. Turk J Med Sci, 2021, 51(SI-1): 3273-3283. PMID: 34773697. PMCID: PMC8771012. DOI: 10.3906/sag-2105-342.
	Yasuhara J, Watanabe K, Takagi H, et al. COVID-19 and multisystem inflammatory syndrome in children: a systematic review and meta-analysis[J]. Pediatr Pulmonol, 2021, 56(5): 837-848. PMID: 33428826. PMCID: PMC8013394. DOI: 10.1002/ppul.25245.
	Belay ED, Abrams J, Oster ME, et al. Trends in geographic and temporal distribution of US children with multisystem inflammatory syndrome during the COVID-19 pandemic[J]. JAMA Pediatr, 2021, 175(8): 837-845. PMID: 33821923. PMCID: PMC8025123. DOI: 10.1001/jamapediatrics.2021.0630.
	Diorio C, Henrickson SE, Vella LA, et al. Multisystem inflammatory syndrome in children and COVID-19 are distinct presentations of SARS-CoV-2[J]. J Clin Invest, 2020, 130(11): 5967-5975. PMID: 32730233. PMCID: PMC7598044. DOI: 10.1172/JCI140970.
	Feldstein LR, Rose EB, Horwitz SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents[J]. N Engl J Med, 2020, 383(4): 334-346. PMID: 32598831. PMCID: PMC7346765. DOI: 10.1056/NEJMoa2021680.
	Saguil A, Fargo M, Grogan S. Diagnosis and management of Kawasaki disease[J]. Am Fam Physician, 2015, 91(6): 365-371. PMID: 25822554.
	Kim SJ. Risk factors related to coronary artery outcome in Kawasaki disease[J]. Korean Circ J, 2018, 48(4): 329-331. PMID: 29625516. PMCID: PMC5889983. DOI: 10.4070/kcj.2018.0077.
	Belot A, Antona D, Renolleau S, et al. SARS-CoV-2-related paediatric inflammatory multisystem syndrome, an epidemiological study, France, 1 March to 17 May 2020[J]. Euro Surveill, 2020, 25(22): 2001010. PMID: 32524957. PMCID: PMC7336112. DOI: 10.2807/1560-7917.ES.2020.25.22.2001010.
	Gruber CN, Patel RS, Trachtman R, et al. Mapping systemic inflammation and antibody responses in multisystem inflammatory syndrome in children (MIS-C)[J]. Cell, 2020, 183(4): 982-995.e14. PMID: 32991843. PMCID: PMC7489877. DOI: 10.1016/j.cell.2020.09.034.
	Weisberg SP, Connors TJ, Zhu Y, et al. Distinct antibody responses to SARS-CoV-2 in children and adults across the COVID-19 clinical spectrum[J]. Nat Immunol, 2021, 22(1): 25-31. PMID: 33154590. PMCID: PMC8136619. DOI: 10.1038/s41590-020-00826-9.
	McMurray JC, May JW, Cunningham MW, et al. Multisystem inflammatory syndrome in children (MIS-C), a post-viral myocarditis and systemic vasculitis-a critical review of its pathogenesis and treatment[J]. Front Pediatr, 2020, 8: 626182. PMID: 33425823. PMCID: PMC7793714. DOI: 10.3389/fped.2020.626182.
	Smatti MK, Cyprian FS, Nasrallah GK, et al. Viruses and autoimmunity: a review on the potential interaction and molecular mechanisms[J]. Viruses, 2019, 11(8): 762. PMID: 31430946. PMCID: PMC6723519. DOI: 10.3390/v11080762.
	Nakra NA, Blumberg DA, Herrera-Guerra A, et al. Multi-system inflammatory syndrome in children (MIS-C) following SARS-CoV-2 infection: review of clinical presentation, hypothetical pathogenesis, and proposed management[J]. Children (Basel), 2020, 7(7): 69. PMID: 32630212. PMCID: PMC7401880. DOI: 10.3390/children7070069.
	Colmenero I, Santonja C, Alonso-Ria?o M, et al. SARS-CoV-2 endothelial infection causes COVID-19 chilblains: histopathological, immunohistochemical and ultrastructural study of seven paediatric cases[J]. Br J Dermatol, 2020, 183(4): 729-737. PMID: 32562567. PMCID: PMC7323219. DOI: 10.1111/bjd.19327.
	Consiglio CR, Cotugno N, Sardh F, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19[J]. Cell, 2020, 183(4): 968-981.e7. PMID: 32966765. PMCID: PMC7474869. DOI: 10.1016/j.cell.2020.09.016.
	Hoste L, Van Paemel R, Haerynck F. Multisystem inflammatory syndrome in children related to COVID-19: a systematic review[J]. Eur J Pediatr, 2021, 180(7): 2019-2034. PMID: 33599835. PMCID: PMC7890544. DOI: 10.1007/s00431-021-03993-5.
	Alotaibi MA, Alhumaidan W, Alotaibi A, et al. Pediatric appendicitis in times of COVID-19: think MIS-C[J]. J Pediatr Surg Case Rep, 2022, 77: 102151. PMID: 34931163. PMCID: PMC8673723. DOI: 10.1016/j.epsc.2021.102151.
	Sharifkashani S, Bafrani MA, Khaboushan AS, et al. Angiotensin-converting enzyme 2 (ACE2) receptor and SARS-CoV-2: potential therapeutic targeting[J]. Eur J Pharmacol, 2020, 884: 173455. PMID: 32745604. PMCID: PMC7834210. DOI: 10.1016/j.ejphar.2020.173455.
	Schwartz SP, Walker TC, Kihlstrom M, et al. Extracorporeal membrane oxygenation for COVID-19-associated multisystem inflammatory syndrome in a 5-year-old[J]. Am Surg, 2022, 88(2): 174-176. PMID: 33372818. PMCID: PMC7780062. DOI: 10.1177/0003134820983198.
	Inciardi RM, Lupi L, Zaccone G, et al. Cardiac involvement in a patient with coronavirus disease 2019 (COVID-19)[J]. JAMA Cardiol, 2020, 5(7): 819-824. PMID: 32219357. PMCID: PMC7364333. DOI: 10.1001/jamacardio.2020.1096.
	Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 2[J]. Arthritis Rheumatol, 2021, 73(4): e13-e29. PMID: 33277976. PMCID: PMC8559788. DOI: 10.1002/art.41616.
	Whittaker E, Bamford A, Kenny J, et al. Clinical characteristics of 58 children with a pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2[J]. JAMA, 2020, 324(3): 259-269. PMID: 32511692. PMCID: PMC7281356. DOI: 10.1001/jama.2020.10369.
	Minocha PK, Phoon CKL, Verma S, et al. Cardiac findings in pediatric patients with multisystem inflammatory syndrome in children associated with COVID-19[J]. Clin Pediatr (Phila), 2021, 60(2): 119-126. PMID: 32975439. DOI: 10.1177/0009922820961771.
	Godfred-Cato S, Abrams JY, Balachandran N, et al. Distinguishing multisystem inflammatory syndrome in children from COVID-19, Kawasaki disease and toxic shock syndrome[J]. Pediatr Infect Dis J, 2022, 41(4): 315-323. PMID: 35093995. PMCID: PMC8919949. DOI: 10.1097/INF.0000000000003449.
	Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 1[J]. Arthritis Rheumatol, 2020, 72(11): 1791-1805. PMID: 32705809. PMCID: PMC7405113. DOI: 10.1002/art.41454.
	Henderson LA, Canna SW, Friedman KG, et al. American College of Rheumatology clinical guidance for multisystem inflammatory syndrome in children associated with SARS-CoV-2 and hyperinflammation in pediatric COVID-19: version 3[J]. Arthritis Rheumatol, 2022, 74(4): e1-e20. PMID: 35118829. PMCID: PMC9011620. DOI: 10.1002/art.42062.
	Sarzaeim M, Rezaei N. Kawasaki disease and multisystem inflammatory syndrome in children with COVID-19[J]. SN Compr Clin Med, 2020, 2(11): 2096-2101. PMID: 33043252. PMCID: PMC7538055. DOI: 10.1007/s42399-020-00558-9.
	Gamez-Gonzalez LB, Moribe-Quintero I, Cisneros-Castolo M, et al. Kawasaki disease shock syndrome: unique and severe subtype of Kawasaki disease[J]. Pediatr Int, 2018, 60(9): 781-790. PMID: 29888440. DOI: 10.1111/ped.13614.
	Ramcharan T, Nolan O, Lai CY, et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital[J]. Pediatr Cardiol, 2020, 41(7): 1391-1401. PMID: 32529358. PMCID: PMC7289638. DOI: 10.1007/s00246-020-02391-2.
	Yamaguchi Y, Takasawa K, Irabu H, et al. Infliximab treatment for refractory COVID-19-associated multisystem inflammatory syndrome in a Japanese child[J]. J Infect Chemother, 2022, 28(6): 814-818. PMID: 35125343. PMCID: PMC8784439. DOI: 10.1016/j.jiac.2022.01.011.
	Jiang L, Tang K, Levin M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents[J]. Lancet Infect Dis, 2020, 20(11): e276-e288. PMID: 32818434. PMCID: PMC7431129. DOI: 10.1016/S1473-3099(20)30651-4.
	Toubiana J, Poirault C, Corsia A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the COVID-19 pandemic in Paris, France: prospective observational study[J]. BMJ, 2020, 369: m2094. PMID: 32493739. PMCID: PMC7500538. DOI: 10.1136/bmj.m2094.