MIS-C治疗:对于轻度病例,单独使用葡萄糖皮质激素治疗是否足够?
Murat Sütçü1, Emine Manolya Kara2, Funda Yıldız3
1Istinye University Faculty of Medicine, Bahçeşehir Liv Hospital, Department of Pediatric Infectious Diseases, Istanbul, Turkey.
The American journal of emergency medicine
|July 13, 2024
概括
葡萄糖皮质激素单一治疗是一种安全有效的治疗轻度多系统炎症综合征 (MIS-C),不涉及心脏. 这种方法可以避免在不那么严重的情况下需要静脉注射免疫球蛋白 (IVIG).
科学领域:
- 儿科 儿科 儿科
- 免疫学 免疫学 免疫学
- 传染性疾病 传染性疾病
背景情况:
- 儿童多系统炎症综合征 (MIS-C) 是一种罕见但严重的疾病.
- 目前的治疗指南经常建议静脉注射免疫球蛋白 (IVIG) 与葡萄皮质激素 (GC) 结合使用.
- 在所有MIS-C病例中,特别是较温和的病例中,IVIG的必要性需要进一步调查.
研究的目的:
- 在轻度多系统炎症综合征 (MIS-C) 病例中,比较葡萄糖皮质醇 (GC) 单疗法与联合GC和静脉免疫球蛋白 (IVIG) 治疗的有效性.
- 评估临床结果,包括疾病进展,休克,儿科重症监护室 (PICU) 的入院,以及需要额外的免疫抑制.
- 在一年的随访中评估心血管和感染相关的并发症.
主要方法:
- 在2020年6月至2022年6月期间接受治疗的97名MIS-C患者的回顾性队列研究.
- 患者被分为两个组:GC单一治疗 (n=65) 和GC+IVIG联合治疗 (n=32).
- 主要结局包括临床恶化,休克,PICU入院和需要进一步的免疫抑制;次要结局是心血管和感染并发症.
主要成果:
- 在这两组中都没有观察到死亡率.
- 所有患者,无论治疗方式如何,表现出正常的心声回声检查结果,并在一年后的随访中没有报告任何投诉.
- 虽然13.5%的患者需要重症监护,33%的患者有心脏发现,但GC单疗对于没有心脏参与的轻度病例来说是足够的.
结论:
- 葡萄糖皮质激素单一治疗似乎是治疗儿童轻度多系统炎症综合征 (MIS-C) 的安全和可行的替代方案,当心脏参与缺席时.
- 这一发现表明,选择MIS-C患者的治疗可能需要降级,避免不必要的IVIG管理.
- 需要进一步的前性研究来证实这些初步发现,并完善MIS-C的治疗方案.
更多相关视频
相关概念视频
Drugs for Treatment of Crohn's Disease in IBD Using Glucocorticoids
114
Glucocorticoids, a class of anti-inflammatory drugs, are pivotal in treating moderate to severe Crohn's disease by inducing remission. They exhibit their anti-inflammatory action by inhibiting the production of inflammatory cytokines such as tumor necrosis factor (TNF)-α, interleukin (IL)-1, and chemokines like IL-8. In addition, they reduce the expression of inflammatory cell adhesion molecules and inhibit gene transcription of nitric oxide synthase, phospholipase A2, cyclooxygenase-2...
114
Drugs for Treatment of Crohn's Disease in IBD Using Immunomodulatory Agents
156
Crohn's disease is an inflammatory bowel disorder marked by chronic inflammation of the GI tract. Various treatment strategies for Crohn's disease are employed, such as immunomodulatory agents, glucocorticoids, and biologics or anti-TNF therapy. Azathioprine (Imuran), a commonly used immunomodulatory drug for Crohn's disease, is converted in the body to mercaptopurine, which inhibits purine biosynthesis and cell proliferation. Both are utilized in severe cases of Inflammatory Bowel...
156
Inflammatory Bowel Disease IV: Pharmacological Management
125
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...
125
Antiasthma Drugs: Mast Cell Stabilizers and Anti-IgE Drugs
267
Asthma is a chronic respiratory condition for which new therapeutic avenues, including anti-inflammatory drugs like mast cell stabilizers and anti-IgE treatments, continue to be developed.
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
Mast cell stabilizers, such as cromolyn (also known as sodium cromoglycate) and nedocromil (Tilade), are effective drugs in asthma management. These stabilizers hinder histamine release by skillfully obstructing the activation of mast cells and other cellular entities. Notably, they navigate this task without...
267
Myasthenia Gravis: Overview and Treatment
1.3K
Myasthenia gravis is a neuromuscular transmission disorder characterized by weakness and increased fatigability of skeletal muscles. It is an autoimmune disease affecting approximately one in 2000 people, where antibodies against the α1 subunit of nicotinic acetylcholine receptors are produced.
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
These antibodies interfere with the function of the nicotinic receptors in three ways: by binding to the receptor and disrupting acetylcholine binding; by causing cross-linking of receptors which...
1.3K
Drugs for Treatment of Ulcerative Colitis in IBD
134
Ulcerative colitis is a chronic inflammatory condition primarily affecting the colon and rectum. The primary drugs used in the treatment of ulcerative colitis are aminosalicylates. They exhibit anti-inflammatory and immunosuppressive properties. They modulate inflammatory mediators and inhibit the activity of nuclear factor κB (NF-κB). Aminosalicylates also reduce inflammation by inhibiting prostaglandin and leukotriene production and decreasing neutrophil chemotaxis and superoxide...
134


