[关于COVID-19相关儿童多系统炎症综合征(PIMS-CT)患者心血管损害的识别、管理和随访建议]。智利科学协会的立场声明]。

Q3 Medicine Revista Chilena de Pediatria-Chile Pub Date : 2020-12-01 Epub Date: 2020-10-08 DOI:10.32641/rchped.vi91i6.3215
Patricia Álvarez Z, Guillermo Larios G, Lida Toro R, Valeria Acevedo A, Francisca Arancibia G, Luis Cárdenas M, Carlos Fernández C
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引用次数: 2

摘要

自SARS-CoV-2大流行开始以来,儿科人群受该疾病的影响在频率和严重程度上都有所减少。然而,自今年4月以来,出现了以影响多个器官的炎症现象为特征的不同表现和严重程度的病例,这种情况被称为儿童多系统炎症综合征(MIS-C)。文献报道频繁的心脏受累,高达80%。其特征是心肌损伤,血清肌钙蛋白I和T、BNP或NT-ProBNP等生物标志物显著增加,并伴有不同程度的心室功能障碍、心包炎、瓣膜炎和心律失常。冠状动脉损伤也有描述,可发生在高达23%的病例中,范围从扩张到动脉瘤。根据心肌损伤(心肌炎、瓣膜炎、心包炎)、休克(通常为血管截瘫)、川崎病型表现以及不符合前三者临床表现的misc等临床表型,对住院、门诊心脏科随访进行了系统化。最后一组代表了短期、中期和长期随访的主要挑战,因此,有必要建立一个多学科团队来管理这些患者。考虑到misc中心脏损害的高频率,以及就其管理和随访达成共识的重要性,我们根据目前对这一最近描述的病理学的了解状况提出这些建议。
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[Recommendation for the recognition, management and follow up of cardiovascular compromise in patients with Pediatric Multisystemic Inflammatory Syndrome associated with COVID-19 (PIMS-CT). Position statement of Chilean Scientific Societies].

Since the onset of the SARS-CoV-2 pandemic, the pediatric population has been less affected by the disease both in frequency and severity. However, since April cases of variable presentation and severity characterized by inflammatory phenomena that affect multiple organs have been reported, a condition called Multisystem Inflammatory Syndrome in Children (MIS-C). The literature has reported frequent cardiac involvement, up to 80%. This is characterized by myocardial injury with a significant increase of biomarkers such as serum troponins I and T, BNP, or NT-ProBNP coupled with varying degrees of ventricular dysfunction, pericarditis, valvulitis, and arrhythmias. Coronary compromise has also been described, which can occur in up to 23% of cases, and ranges from dila tations to aneurysms. Inpatient and outpatient cardiology follow-up has been systematized based on the clinical phenotypes such as myocardial injury (myocarditis, valvulitis, pericarditis), shock (usua lly vasoplegic), Kawasaki disease-type manifestations, and those MIS-C that do not comply with the clinic of the previous three. This last group represents the main challenge in the short-, medium- and long-term follow-up, therefore, it is necessary a multidisciplinary team for managing these patients. Considering the high frequency of cardiac compromise in MIS-C, and the importance of reaching a consensus regarding its management and follow-up, we present these recommendations according to the current state of knowledge regarding this recently described pathology.

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