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研究发现部分儿童感染新冠病毒后患重症
Children and Coronavirus: Research Finds Some Become Seriously Ill

来源:纽约时报    2020-03-18 06:38



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        The coronavirus raging around the globe has tended to tread gently with children, who account for the smallest percentage of the tens of thousands of infections identified so far.        肆虐全球的新冠病毒对儿童往往较为温和,在目前已确认的数万例感染中,儿童所占比例最小。
        Now, the largest study to date of children and the virus has found that while most develop mild or moderate symptoms, a small percentage — especially babies and preschoolers — can become seriously ill.        迄今为止对儿童和病毒进行的最大规模的研究发现,虽然大多数儿童出现轻度或中度症状,但有一小部分人——特别是婴儿和学龄前儿童——可能会患重病。
        The study, published online in the journal Pediatrics, looked at more than 2,000 ill children across China, where the pandemic began. It provides a clearer portrait of how the youngest patients are affected by the virus, knowledge that experts say can help influence policies like school closures, hospital preparedness and the deployment of an eventual treatment and vaccine.        这项研究发表在《儿科》(Pediatrics)杂志网络版上,研究对象是这场大流行的起始点中国的2000多名患病儿童。研究更加清楚地描述了年幼的患者是如何被病毒感染的,专家们表示,这些知识可以在诸如停课、医院准备以及最终治疗和疫苗的部署等政策制定上提供帮助。
        The researchers analyzed 2,143 cases of children under 18 that were reported to the Chinese Centers for Disease Control and Prevention as of Feb. 8. Just over a third of those cases were confirmed with laboratory testing. The rest were classified as suspected cases based on the child’s symptoms, chest X-rays, blood tests and whether the child had been exposed to people with coronavirus.        研究人员分析了2月8日中国疾病预防控制中心报告的2143例18岁以下的患病儿童。只有三分之一多的病例通过实验室检测得到确诊。其余根据孩子的症状、胸片、验血以及是否接触过新冠病毒感染者,被归类为疑似病例。
        About half of the children had mild symptoms, such as fever, fatigue, cough, congestion and possibly nausea or diarrhea. More than a third — about 39 percent — became moderately sick, with additional symptoms including pneumonia or lung problems revealed by CT scan, but with no obvious shortness of breath. About 4 percent had no symptoms at all.        大约一半的儿童有轻微的症状,如发热、疲劳、咳嗽、鼻塞,可能还有恶心或腹泻。超过三分之一(约39%)的患者病情中等,CT扫描显示有肺炎或其他肺部症状,但没有明显的呼吸困难。大约4%的人没有任何症状。
        But there were 125 children — nearly 6 percent— who developed very serious illness, and one 14-year-old boy with confirmed coronavirus infection died, said Shilu Tong, the study’s senior author, who is director of the department of clinical epidemiology and biostatistics at Shanghai Children’s Medical Center. Thirteen of those were considered “critical," on the brink of respiratory or organ failure. The others were classified as “severe” because they had dire respiratory problems.        但是,该研究的资深作者、上海儿童医学中心临床流行病学和生物统计学系主任童世庐说,仍有125名儿童——将近6%——患上了严重疾病,并有一名14岁的确诊男孩死亡。这些病例中有13例处于呼吸或器官衰竭的边缘,被认为是“危重症”。其他则因为严重的呼吸系统疾病而被分类为“重症”。
        “Effectively, what this tells us is that hospitals should prepare for some pediatric patients because we can’t rule out children altogether,” said Dr. Srinivas Murthy, an associate professor of pediatrics at the University of British Columbia, who was not involved in the study.        不列颠哥伦比亚大学(University of British Columbia)的儿科学助理教授、没有参与该研究的斯瑞尼瓦斯·穆尔蒂(Srinivas Murthy)博士说:“这实际上在告诉我们,医院应该如何为儿科患者做好准备,因为我们不能完全排除儿童患病。”
        “The main conclusion,” Dr. Murthy continued, “is that children are infected at rates that may be comparable to adults, with severity that’s much less, but that even within the kids, there’s a spectrum of illness and there’s a handful that require more aggressive therapy.”        穆尔蒂说:“主要结论是儿童的感染率与成人可能是相当的,严重程度要低得多,但是即使在儿童中,也存在多种病症,并且有少数病例需要更积极的治疗。”
        More than 60 percent of the 125 children who became severely ill or critically ill were age 5 or younger, the study reported. Forty of those were infants, under 12 months old.        该研究报告说,在125名重症或危重症儿童中,有60%以上在5岁或5岁以下。其中有40例是不满12个月的婴儿。
        Dr. Tong said he believed that younger children were more susceptible to infection because their respiratory systems and other body functions are rapidly developing.        童世庐说,他相信幼童更容易受到感染,因为他们的呼吸系统和其他身体机能正在迅速发育。
        Dr. Andrea Cruz, an associate professor of pediatrics of Baylor College of Medicine and co-author of a commentary about the study, said that preschoolers and babies likely get sicker because of their “immune system immaturity.”        贝勒医学院(Baylor College of Medicine)的儿科助理教授安德烈·克鲁兹(Andrea Cruz)博士与他人合著了对该研究的评论文章。他说,学龄前儿童和婴儿的病情可能由于“免疫系统不成熟”而加重。
        “They haven’t been exposed to viruses before and therefore they can’t mount an effective immune response,” she said in an interview.        她在一次采访中说:“他们以前还未接触过病毒,因此无法进行有效的免疫反应。”
        Scientists are actively trying to determine why so many children appear to emerge relatively unscathed by the new coronavirus, a pattern that also characterized the earlier outbreaks of the closely-related SARS virus in China and MERS in the Middle East. Cases of children with the new coronavirus infection in Italy, Singapore and South Korea seem to be similar, Dr. Murthy said.        科学家们正在努力明确为什么如此多的儿童在感染病毒后似乎丝毫未受影响,这种特征也出现在关系相近的病毒的暴发中——曾经的中国SARS暴发和中东地区的MERS暴发。穆尔蒂说,在意大利、新加坡和韩国,感染新型冠状病毒的儿童病例看上去是相似的。
        A theory that is gaining increasing currency is that the receptor or protein in human cells that the viral particles bind to, called the ACE2 receptor, is not expressed as prominently in young children or might be a different shape, Dr. Murthy said.        穆尔蒂说,一种越来越流行的理论是,病毒分子与人类细胞中称为ACE2的受体或蛋白质相结合,这种受体在幼儿中的表达不突出,或者以不同的形式表达。
        “It might not be as developed in children as in adults,” he said, which might make it tougher for the spikes on the tiny viral particles to bind and gain entry to the cells so the virus can replicate.        他说:“它在儿童体内可能不像在成人体内那样发展。”这可能会使微小病毒颗粒的刺突难以结合并进入细胞以进行自我复制。
        Another theory is that “most kids have healthier lungs” than adults, Dr. Cruz said. Adults have likely been more exposed to pollution over their lifetime and adults with severe coronavirus disease have tended to have underlying health conditions or weakened or aging immune systems.        克鲁兹说,另一个理论是“大多数孩子的肺比成年人更健康”。成年人很可能在多年的生活中更多地暴露于污染,而且患有严重冠状病毒疾病的成年人往往具有潜在的健康问题,或衰弱、老化的免疫系统。
        It’s also possible, experts say, that children’s immune systems don’t rev up to attack the virus as much as adult immune systems do. Doctors have found that some of the serious damage infected adults have endured has been caused not just by the virus itself, but by an aggressive immune response that creates destructive inflammation in the body’s organs.        专家们说,儿童的免疫系统也可能不像成人免疫系统那样迅速启动以攻击病毒。医生发现,受感染的成年人遭受的一些严重损害不仅是由病毒本身引起的,而且还包括在人体器官中的剧烈免疫反应,导致破坏性的炎症。
        The new study, while large and included cases across China, not just where the outbreak originated in Wuhan, leaves many unanswered questions. For example, the researchers found that more of the severe and critical cases were in children with suspected — instead of confirmed — coronavirus infection, raising the possibility that other infections wreaked havoc on their bodies, in addition to or possibly even instead of Covid-19.        这项新研究虽然规模庞大,涉及不仅是武汉而且遍布中国各地的病例,但仍然留下了许多悬而未决的问题。例如,研究人员发现,更多的重症和危重儿童属于冠状病毒疑似病例——而不是确诊病例,这增加了除Covid-19之外还有其他感染导致身体器官遭受损害的可能性,甚至跟Covid-19无关。
        It’s also unclear whether the United States can expect the relatively small numbers of child cases reported in China or should brace for more.        同样不清楚的是,美国是否可以使用中国报告的相对较少的儿童感染病例比例进行预测,还是应该为比这更多的病例做好准备。
        “The age pyramid in China is really different than the U.S. — they have a lot fewer kids than we do,” said Dr. Cruz, who believes, as other experts do, that large numbers of people with mild or asymptomatic disease have not been recorded because testing was not done in those cases. “You’ve had a lot of under-testing in children because the focus has been on adults. It’s likely we’ve been underestimating the disease burden in kids.”        克鲁兹说:“中国的年龄结构确实与美国不同——他们的儿童比我们少得多。”克鲁兹相信,和其他专家一样,大量轻症或无症状病例未被记录,因为这些病例未进行病毒测试。“因为针对重点是成年人,所以对儿童的测试做的不够。我们可能一直低估了儿童的疾病负担。”
        Answering questions about coronavirus in children could reverberate well beyond the pediatric population. It could shed light why some patients are most at risk. And, said Dr. Murthy, studying the physiology of those who are less affected could help in the development of treatment and a vaccine.        解答有关感染冠状病毒的儿童的问题所引发的回应,很可能会超越儿科领域。这也许能解释为什么某些患者有极高的风险。穆尔蒂说,对受影响较小的人的生理状况进行研究,可能有助于诊疗和疫苗的开发。
                
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