兒童多系統發炎症候群MIS-C介紹與藥物治療

Pediatric Multisystem Inflammatory Syndrome (MIS-C): Overview and Pharmacological Treatment

10.6168/FJCP.202401_32(1).0003

黃振彰(Chen-Chang Huang)；黃雅筠(Ya-Yun, Huang)；楊璦瑜(Ai-Yu Yang)；王詩涵(Shih-Han Wang)

兒童多系統發炎症候群 ； MIS-C ； 川崎氏症 ； IVIG ； anakinra ； Multisystem inflammatory syndrome in children ； MIS-C ； Kawasaki disease ； IVIG ； anakinra

臺灣臨床藥學雜誌

32卷1期（2024 / 01 / 31）

21 - 29

繁體中文;英文

席捲全球的COVID-19，一開始發現原始病毒株在兒童族群的影響較小，但2020年4月通報了兒童族群首例和COVID-19相關、少見但嚴重的發炎反應，包括全身性發炎反應、低血壓與心臟功能異常等症狀；其特徵與川崎氏症（Kawasaki disease, KD）、巨噬細胞活化症候群與毒性休克症候群的症狀相似。後續定名為Multisystem inflammatory syndrome in children（MIS-C）。由於症狀與KD相似，因此初始治療方式也是參考KD的治療。除了支持性療法以外，目前治療建議以免疫球蛋白（intravenous immunoglobulin, IVIG）作為治療的首選，此外類固醇可做為替代療法或合併IVIG使用。如果治療效果不佳時可採用抗細胞激素療法的藥品治療，anakinra是目前首選的建議，此外infliximab與tocilizumab也有成功治療的案例報告。MIS-C也有產生血栓的風險，一般建議給予低劑量的aspirin，而在嚴重冠狀動脈瘤或左心功能異常時建議給予抗凝血劑做預防與治療。MIS-C的症狀嚴重，但幸運的是經治療後的成效良好。期許未來有更多隨機分派的臨床試驗結果，能得到MIS-C的最佳治療策略。

The global impact of COVID-19 was initially observed to have a lesser effect on the pediatric population. However, in April 2020, the first reported case of a rare but severe inflammatory response related to COVID-19 in children was reported. This response included symptoms such as systemic inflammation, low blood pressure, and cardiac abnormalities. The characteristics of these symptoms seen in Kawasaki disease (KD), macrophage activation syndrome (MAS), and toxic shock syndrome (TSS). Subsequently, it was named Multisystem Inflammatory Syndrome in Children (MIS-C). Due to the similarity in symptoms with KD, the initial treatment approach was based on KD therapy. Apart from supportive care, the current treatment recommendations prioritize intravenous immunoglobulin (IVIG) as the first-line treatment. Additionally, steroids can be used as an alternative or in combination with IVIG. In cases where the initial treatment proves ineffective, drugs for anti-cellular cytokine therapy can be employed. Anakinra is currently the preferred choice, and successful treatment cases have also been reported with infliximab and tocilizumab. MIS-C also has a risk of thrombosis, and it is generally recommended to administer low-dose aspirin. In cases of severe coronary artery aneurysms or left ventricular dysfunction, anticoagulants are recommended for the prevention and treatment thrombosis. Although MIS-C symptoms can be severe, fortunate outcomes have been observed after treatment. It is hoped that future randomized clinical trial results will provide the optimal treatment strategy for MIS-C.