新冠肺炎患儿胃肠道表现的系统评价

S. Salvatore, M. Agosti, S. Arrigo, M. Stracuzzi, D. Dilillo, L. Folgori, R. Giacchero, V. Giacomet, E. Longoni, A. Meini, G. Marseglia, A. Plebani, A. Ruffolo, L. Barcellini, G. Zuccotti
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引用次数: 1

摘要

严重急性呼吸系统综合征冠状病毒2型感染通常表现为轻度至重度呼吸道症状,并可能涉及其他器官。胃肠道表现在成年患者中经常被记录,而在儿童中的发生率尚不确定。本研究旨在对患有冠状病毒疾病(新冠肺炎)的儿童的胃肠道症状进行系统回顾,并将这些临床发现与大流行早期意大利儿童队列中报告的结果进行比较。方法:根据PRISMA指南,从2019年12月1日至2020年4月28日,使用Cochrane图书馆和MEDLINE(通过Pubmed)数据库进行文献检索。插入了以下搜索词:“冠状病毒”或“新冠肺炎”或“SARS-CoV-2”和“胃肠道”或“腹泻”。只有包括儿童(0-18岁)和胃肠道症状在内的论文才被视为合格。还收集、分析和比较了3月1日至4月28日居住在意大利伦巴第的儿童通过咽拭子rRT PCR诊断感染严重急性呼吸系统综合征冠状病毒2型的数据记录。结果:系统综述显示,只有少数研究评估了儿童的胃肠道症状。然而,腹泻占感染儿童的0-50%,呕吐占5-67%,腹痛占5.8-33.3%,胃肠道症状可能是新冠肺炎的唯一特征。意大利感染严重急性呼吸系统综合征冠状病毒2型的儿童中有51/116(44%)出现胃肠道症状。23.3%的儿童喂养不良,22.4%的儿童腹泻(中位持续时间2.3天,范围1-5天),10.4%的儿童呕吐,6.9%的儿童腹痛。35.3%的胃肠道症状儿童出现呼吸道症状,这是25%的新冠肺炎患者的首次临床表现。结论:我们发现胃肠道症状在新冠肺炎儿童中很常见,在某些情况下,它们可能是SARS-CoV-2感染的第一种也是唯一的临床表现。卫生保健专业人员必须意识到儿童胃肠道的频繁介入,以确保准确的诊断和治疗管理。正确识别新冠肺炎儿童对于采取预防措施和限制病毒传播也至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A Systematic Review of Gastrointestinal Manifestations in Children Presenting with COVID-19
SARS-CoV-2 infection commonly presents with mild to severe respiratory symptoms and possibly other organs involvement. Gastrointestinal manifestations have been frequently documented in adult patients whilst their occurrence in children is uncertain. This study aimed to perform a Systematic Review of gastrointestinal symptoms in children with Coronavirus disease (COVID-19) and to compare these clinical findings with those reported in a cohort of Italian children in the early phase of pandemic. Methods: Literature search was conducted using the Cochrane Library and MEDLINE (via Pubmed) databases from 1st December 2019 to 28th April 2020, according to the PRISMA guidelines. The following search terms were inserted: “Coronavirus” OR “COVID-19” OR “SARS-CoV-2” AND “gastrointestinal” or “diarrhea”. Only papers including children (0-18 years) and gastrointestinal symptoms were considered as eligible. Data records of children living in Lombardy, Italy, with infection of SARS-CoV-2 diagnosed by rRT-PCR on pharyngeal swabs, from 1st March to 28th April were also collected, analyzed and compared. Results: The Systematic Review showed that only a minority of studies assessed gastrointestinal symptoms in children. However, diarrhea accounted for 0-50%, vomit 5-67% and abdominal pain 5.8-33.3% of infected children and gastrointestinal symptoms may represent the sole feature of COVID-19. Gastrointestinal symptoms were reported in 51/116 (44%) Italian children with SARS-CoV-2 infection. Poor feeding was present in 23.3% of children, diarrhea (median duration 2.3 days, range 1-5 days) in 22.4%, vomit in 10.4% and abdominal pain in 6.9% of cases. Respiratory symptoms were reported in 35.3% of children with gastrointestinal symptoms that represented the first clinical manifestation of COVID-19 in 25% of all patients. Conclusions: We found that gastrointestinal symptoms are common in children with COVID-19 and, in some cases, they may represent the first and the sole clinical manifestation of SARS-CoV-2 infection. Health care professionals must be aware of the frequent gastrointestinal involvement in children to assure an accurate diagnosis and therapeutic management. The correct identification of children with COVID-19 is also crucial to adopt preventive measures and to limit the transmission of the virus. 
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