Journal of Clinical Pediatrics ›› 2023, Vol. 41 ›› Issue (7): 486-491.doi: 10.12372/jcp.2022.23e0317
• Original article • Previous Articles Next Articles
HAO Sheng, HUANG Min
Received:
2023-04-13
Published:
2023-07-15
Online:
2023-07-05
HAO Sheng, HUANG Min. Clinical diagnosis and treatment of Kawasaki disease-associated macrophage activation syndrome in children[J].Journal of Clinical Pediatrics, 2023, 41(7): 486-491.
"
HLH-20041) | HLH-20091) | 2016SJIA-MAS共识标准2) | 2020KD-MAS共识标准2) |
---|---|---|---|
以下8条至少符合5条: (1)发热:体温>38.5℃,持续>7 d (2)脾大 (3)血细胞减少(两系或三系) Hb<90 g·L-1(4周以内婴儿Hb<100 g·L-1) PLT<100×109·L-1 中性粒细胞<1.0×10·L-1,且非骨髓造血功能减低所致 (4)高三酰甘油血症(空腹三酰甘油>3.0 mmol·L-1或265 mg·dL-1)和/或低纤维蛋白原血症( <1.5g·L-1) (5)骨髓、肝脏、脾脏、淋巴结发现噬血细胞 (6)NK细胞活性降低或完全缺乏 (7)血清铁蛋白>500 μg·L-1 (8)可溶性CD25(可溶性IL-2受体)≥2 400 U·mL-1 | (1)以下4条至少符合3条: ①发热 ②脾大 ③血细胞减少(外周血三系中至少两系以上减少) ④肝炎表现 (2)以下4条至少符合1条: ①骨髓、脾脏或淋巴结中发现噬血现象 ②铁蛋白升高 ③可溶性L-2受体(SCD25)水平升高(有年龄相关性) ④NK细胞活性减低或缺失 (3)其他支持HLH诊断的指标: ①高三酰甘油血症 ②低纤维蛋白原血症 ③低钠血症 | (1)铁蛋白>684 mg·mL-1 (2)血小板≤181×109·L-1 (3)天门冬氨酸氨基转移酶>48 U·L-1 (4)三酰甘油>1 560 mg·L-1 (1.76 mmol·L-1) (5)纤维蛋白原≤3 600 mg·L-1 诊断条件:(1)为必备条件,(2)~(5)满足任意2条或2条以上(需排除伴发免疫介导的血小板减少症,传染性肝炎、内脏利什曼病和家族性高脂血症等疾病) | (1)铁蛋白进行性升高 (2)血小板急剧下降 (3)天门冬氨酸氨基转移酶高于基线数倍 (4)三酰甘油急剧升高 (5)纤维蛋白原明显降低 (6)骨髓或其他组织(淋巴结、肝脏、脾脏等)发现噬血细胞 诊断条件:(1)为必备条件 (罕见病例除外),(2)~(6)满足任意2条或2条以上 |
[1] |
Gorelik M, Chung SA, Ardalan K, et al. 2021 American College of Rheumatology/Vasculitis Foundation Guideline for the Management of Kawasaki Disease[J]. Arthritis Care Res (Hoboken), 2022, 74(4): 538-548.
doi: 10.1002/acr.v74.4 |
[2] |
Saadoun D, Vautier M, Cacoub P. Medium- and large-vessel vasculitis[J]. Circulation, 2021, 143(3): 267-282.
doi: 10.1161/CIRCULATIONAHA.120.046657 pmid: 33464968 |
[3] |
Tirelli F, Marrani E, Giani T, et al. One year in review: Kawasaki disease[J]. Curr Opin Rheumatol, 2020, 32(1): 15‐20.
doi: 10.1097/BOR.0000000000000671 pmid: 31599798 |
[4] |
McGonagle D, Ramanan AV, Bridgewood C. Immune cartography of macrophage activation syndrome in the COVID-19 era[J]. Nat Rev Rheumatol, 2021, 17(3): 145-157.
doi: 10.1038/s41584-020-00571-1 pmid: 33547426 |
[5] |
Wang W, Gong F, Zhu W, et al. Macrophage activation syndrome in Kawasaki disease: more common than we thought?[J]. Semin Arthritis Rheum, 2015, 44(4): 405-410.
doi: 10.1016/j.semarthrit.2014.07.007 |
[6] |
Crayne C, Cron RQ. Pediatric macrophage activation syndrome, recognizing the tip of the Iceberg[J]. Eur J Rheumatol, 2020, 7(Suppl 1): 13-20.
doi: 10.5152/eurjrheumatol. |
[7] | 郝胜. 儿童风湿性疾病相关巨噬细胞活化综合征诊断与治疗专家共识之五——川崎病篇[J]. 中国实用儿科杂志, 2020, 35(11): 23-27. |
[8] |
Pilania RK, Jindal AK, Johnson N, et al. Macrophage activation syndrome in children with Kawasaki disease: an experience from a tertiary care hospital in northwest India[J]. Rheumatology (Oxford), 2021, 60(7): 3413-3419.
doi: 10.1093/rheumatology/keaa715 pmid: 33221920 |
[9] |
Filipovich AH, Chandrakasan S. Pathogenesis of hemophagocytic lymphohistiocytosis[J]. Hematol Oncol Clin North Am, 2015, 29(5): 895-902.
doi: 10.1016/j.hoc.2015.06.007 |
[10] |
Crayne CB, Albeituni S, Nichols KE, et al. The immu-nology of macrophage activation syndrome[J]. Front Immunol, 2019, 10: 119.
doi: 10.3389/fimmu.2019.00119 |
[11] |
Zhang M, Behrens EM, Atkinson TP, et al. Genetic defects in cytolysis in macrophage activation syndrome[J]. Curr Rheumatol Rep, 2014, 16(9): 439.
doi: 10.1007/s11926-014-0439-2 pmid: 25086802 |
[12] |
Kaufman KM, Linghu B, Szustakowski JD, et al. Whole-exome sequencing reveals overlap between macrophage activation syndrome in systemic juvenile idiopathic arthritis and familial hemophagocytic lymphohistiocytosis[J]. Arthritis Rheumatol, 2014, 66(12): 3486-3495.
doi: 10.1002/art.v66.12 |
[13] |
Brisse E, Wouters C, Matthys P. Advances in the pathogenesis of primary and secondary haemophagocytic lymphohistiocytosis: differences and similarities[J]. Br J Haematol, 2016, 174(2): 203-217.
doi: 10.1111/bjh.2016.174.issue-2 |
[14] | Carter SJ, Tattersall R, Ramanan AV, et al. Macrophage activation syndrome in adults: recent advances in pathophysiology, diagnosis and treatment[J]. Rheu-matology (Oxford), 2019, 58(1): 5-17. |
[15] |
Jinkawa A, Shimizu M, Nishida K, et al. Cytokine profile of macrophage activation syndrome associated with Kawasaki disease[J]. Cytokine, 2019, 119: 52-56.
doi: S1043-4666(19)30073-0 pmid: 30877950 |
[16] |
Han SB, Lee SY. Macrophage activation syndrome in children with Kawasaki disease: diagnostic and therapeutic approaches[J]. World J Pediatr, 2020, 16(6): 566-574.
doi: 10.1007/s12519-020-00360-6 |
[17] | 周利兵, 吕海涛. 川崎病并发巨噬细胞活化综合征的研究进展[J]. 临床儿科杂志, 2018, 36(10): 74-78. |
[18] |
Jin P, Luo Y, Liu X, et al. Kawasaki disease complicated with macrophage activation syndrome: case reports and literature review[J]. Front Pediatr, 2019, 7: 423.
doi: 10.3389/fped.2019.00423 pmid: 31737585 |
[19] |
Kang H, Kwon YH, Yoo E, et al. Clinical characteristics of hemophagocytic lymphohistiocytosis following Kawasaki disease: differentiation from recurrent Kawasaki disease[J]. Blood Res, 2013, 48(4): 254-257.
doi: 10.5045/br.2013.48.4.254 |
[20] |
García-Pavón S, Yamazaki-Nakashimada MA, Báez M, et al. Kawasaki disease complicated with macrophage activation syndrome: a systematic review[J]. J Pediatr Hematol Oncol, 2017, 39(6): 445-451.
doi: 10.1097/MPH.0000000000000872 |
[21] | Zhang HY, Xiao M, Zhou D, et al. Platelet and ferritin as early predictive factors for the development of macrophage activation syndrome in children with Kawasaki disease: a retrospective case-control study[J]. Front Pediatr, 2023, 11: 1088525. |
[22] | 何胜男, 唐雪梅, 张宇, 等. 川崎病相关巨噬细胞活化综合征临床分析及诊断标准初探[J]. 中华实用儿科临床杂志, 2018, 33(9): 679-683. |
[23] | 何涛, 钟家蓉, 张静. 川崎病并发巨噬细胞活化综合征9例病例报告并文献复习[J]. 中国循证儿科杂志, 2018, 13(6): 421-426. |
[24] |
Nofech-Mozes Y, Garty BZ. Thrombocytopenia in Kawasaki disease: a risk factor for the development of coronary artery aneurysms[J]. Pediatr Hematol Oncol, 2003, 20(8): 597-601.
pmid: 14578029 |
[25] |
Bode SF, Lehmberg K, Maul-Pavicic A, et al. Recent advances in the diagnosis and treatment of hemophagocytic lymphohistiocytosis[J]. Arthritis Res Ther, 2012, 14(3): 213.
doi: 10.1186/ar3843 pmid: 22682420 |
[26] |
Grom AA, Horne A, De Benedetti F. Macrophage activation syndrome in the era of biologic therapy[J]. Nat Rev Rheumatol, 2016, 12(5): 259‐268.
doi: 10.1038/nrrheum.2015.179 pmid: 27009539 |
[27] |
Sharma C, Ganigara M, Galeotti C, et al. Multisystem inflammatory syndrome in children and Kawasaki disease: a critical comparison[J]. Nat Rev Rheumatol, 2021, 17(12): 731-748.
doi: 10.1038/s41584-021-00709-9 pmid: 34716418 |
[28] |
Otar Yener G, Paç Kısaarslan A, Ulu K, et al. Differences and similarities of multisystem inflammatory syndrome in children, Kawasaki disease and macrophage activating syndrome due to systemic juvenile idiopathic arthritis: a comparative study[J]. Rheumatol Int, 2022, 42(5): 879-889.
doi: 10.1007/s00296-021-04980-7 |
[29] |
Bukulmez H. Current understanding of multisystem inflammatory syndrome (MIS-C) following COVID-19 and its distinction from Kawasaki disease[J]. Curr Rheumatol Rep, 2021, 23(8): 58.
doi: 10.1007/s11926-021-01028-4 pmid: 34216296 |
[30] |
Lopez-Leon S, Wegman-Ostrosky T, Ayuzo Del Valle NC, et al. Long-COVID in children and adolescents: a systematic review and meta-analyses[J]. Sci Rep, 2022, 12(1): 9950.
doi: 10.1038/s41598-022-13495-5 pmid: 35739136 |
[31] |
Tong T, Yao X, Lin Z, et al. Similarities and differences between MIS-C and KD: a systematic review and meta-analysis[J]. Pediatr Rheumatol Online J, 2022, 20(1): 112.
doi: 10.1186/s12969-022-00771-x pmid: 36471327 |
[32] |
Beukelman T, Patkar NM, Saag KG, et al. 2011 American College of Rheumatology recommendations for the treatment of juvenile idiopathic arthritis: initiation and safety monitoring of therapeutic agents for the treatment of arthritis and systemic features[J]. Arthritis Care Res (Hoboken), 2011, 63(4): 465‐482.
doi: 10.1002/acr.20460 pmid: 21452260 |
[33] |
Locatelli F, Jordan MB, Allen C, et al. Emapalumab in children with primary hemophagocytic lymphohistiocytosis[J]. N Engl J Med, 2020, 382(19): 1811-1822.
doi: 10.1056/NEJMoa1911326 |
[34] |
De Benedetti F, Grom AA, Brogan PA, et al. Efficacy and safety of emapalumab in macrophage activation syndrome[J]. Ann Rheum Dis, 2023, 82(6): 857-865.
doi: 10.1136/ard-2022-223739 |
[35] | 郝胜, 黄文彦, 曾华松. 小分子靶向JAK抑制剂在儿童风湿免疫性疾病中的应用[J]. 中国实用儿科杂志, 2021, 36(11): 853-857. |
[36] | 赵坚, 谢利剑, 肖婷婷, 等. 联合体外膜肺治疗川崎病休克综合征1例报告并文献复习[J]. 临床儿科杂志, 2019, 37(9): 708-711. |
[37] |
Kim HK, Kim HG, Cho SJ, et al. Clinical characteristics of hemophagocytic lymphohistiocytosis related to Kawasaki disease[J]. Pediatr Hematol Oncol, 2011, 28(3): 230-236.
doi: 10.3109/08880018.2010.526685 pmid: 21381871 |
[38] |
Choi JE, Kwak Y, Huh JW, et al. Differentiation between incomplete Kawasaki disease and secondary hemophagocytic lymphohistiocytosis following Kawasaki disease using N-terminal pro-brain natriuretic peptide[J]. Korean J Pediatr, 2018, 61(5): 167-173.
doi: 10.3345/kjp.2018.61.5.167 pmid: 29853942 |
[39] |
Latino GA, Manlhiot C, Yeung RS, et al. Macrophage activation syndrome in the acute phase of Kawasaki disease[J]. J Pediatr Hematol Oncol, 2010, 32(7): 527-531.
doi: 10.1097/MPH.0b013e3181dccbf4 |
[40] |
Zou LX, Zhu Y, Sun L, et al. Clinical and laboratory features, treatment, and outcomes of macrophage activation syndrome in 80 children: a multi-center study in China[J]. World J Pediatr, 2020, 16(1): 89-98.
doi: 10.1007/s12519-019-00256-0 |
[1] | LUO Mingjing, YU Jiaming, WANG Xiaodong, ZHANG Xiaoling, YU Yue, ZHANG Yu, WEN Feiqiu, LIU Sixi. Clinical analysis of invasive fungal disease secondary to allogeneic hematopoietic stem cell transplantation in 424 children with thalassemia [J]. Journal of Clinical Pediatrics, 2025, 43(1): 21-28. |
[2] | LIU Dongxia, JIN Rong, LIN Rongjun. Risk factors analysis of severe refractory Mycoplasma pneumoniae pneumonia complicated with bronchitis obliterans in children [J]. Journal of Clinical Pediatrics, 2025, 43(1): 29-34. |
[3] | ZHONG Jinhong, WANG Can, CHEN Fang. Progress in the research of infantile fiberoptic bronchoscopy sedation [J]. Journal of Clinical Pediatrics, 2025, 43(1): 50-55. |
[4] | JIANG Weiqin, WANG Jing, CHENG Anna, CHEN Tingting, HUANG Yujuan. Predictors of recurrent febrile seizures during the same febrile illness in children with febrile seizures [J]. Journal of Clinical Pediatrics, 2025, 43(1): 8-13. |
[5] | QIU Xiu, WEI Dongmei, LIN Shanshan, XIA Huimin, ZHOU Wenhao. Principles and practice of the Born in Guangzhou Cohort Study [J]. Journal of Clinical Pediatrics, 2024, 42(9): 747-752. |
[6] | FAN Jianxia. The origins and development of the healthy life trajectory program: a cohort of community-family-mother-child multidimensional interventions for overweight and obesity in children [J]. Journal of Clinical Pediatrics, 2024, 42(9): 768-773. |
[7] | JIANG Tao, LI Shuangjie, TANG Lian, OUYANG Wenxian. Immunobiological properties of peripheral blood MAIT cells in children with chronic hepatitis B [J]. Journal of Clinical Pediatrics, 2024, 42(9): 787-790. |
[8] | ZHOU Jie, LIU Keqiang, WANG Jinling, WANG Ying. Megacystis-microcolon-intestinal hypoperistalsis syndrome caused by MYH11 elongating mutation : a case report and literatures review [J]. Journal of Clinical Pediatrics, 2024, 42(9): 798-804. |
[9] | CHU Sijia, TANG Jihong. Research progress of central nervous system injury associated with pediatric acute lymphoblastic leukemia and its treatment [J]. Journal of Clinical Pediatrics, 2024, 42(9): 811-816. |
[10] | DING Yaping, XIA Shanshan, ZHANG Chenmei. Interpretation of “2023 Children’s Renal Nutrition Working Group Clinical Practice Recommendations: Nutritional Management of Children with Acute Kidney Injury” [J]. Journal of Clinical Pediatrics, 2024, 42(8): 667-672. |
[11] | LI Yirong, LI Huiping, GAO Jingyu, XIAO Yuhua, CHEN Xiaomin, LU Yanling, ZHAO Nana, FENG Xiaoqin. Comparison of different doses of cytarabine for induction chemotherapy in children with acute myeloid leukemia in FLAG-IDA regimen [J]. Journal of Clinical Pediatrics, 2024, 42(8): 673-677. |
[12] | HUANG Bo, DONG Yanying, SONG Linlan. Clinical characteristics of 348 children with infectious mononucleosis [J]. Journal of Clinical Pediatrics, 2024, 42(8): 678-683. |
[13] | WANG Dan, SHAO Jingbo, LI Hong, ZHANG Na, ZHU Jiashi, FU Pan, WANG Zhen. Clinical analysis of 38 cases of hematological malignancies complicated with tumor lysis syndrome in children [J]. Journal of Clinical Pediatrics, 2024, 42(8): 684-690. |
[14] | MA Yan, WEI Xingjiao, BAI Hua, ZHANG Yan, TIAN Xinmin, Aqsa Ahmad, LIANG Lijun. Analysis of etiological composition and clinical features of stage 5 chronic kidney disease in children in a tertiary hospital in western China [J]. Journal of Clinical Pediatrics, 2024, 42(8): 697-703. |
[15] | WANG Ye, ZHANG Linlin, CHI Zuofei, SUN Ruowen, JIANG Zehui, XU Gang. A case of clinical report of T-lymphoblastic lymphoma secondary to acute promyelocytic leukemia in children [J]. Journal of Clinical Pediatrics, 2024, 42(8): 722-727. |
|