Observational cohort study of neurological involvement among patients with SARS-CoV-2 infection.
Observational cohort study of neurological involvement among patients with SARS-CoV-2 infection.
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DOI：
10.1177/1756286421993701
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发表时间：
2021
影响因子：
5.9
通讯作者：
Stettner M
中科院分区：
文献类型：
--
作者：
Fleischer M;Köhrmann M;Dolff S;Szepanowski F;Schmidt K;Herbstreit F;Güngör C;Stolte B;Steiner KM;Stadtler C;Riße J;Fiedler M;Meyer Zu Hörste G;Mausberg AK;Kill C;Forsting M;Sure U;Dittmer U;Witzke O;Brenner T;Kleinschnitz C;Stettner M
越来越多的报告表明，SARS-CoV-2感染往往会导致神经系统受累;然而，关于发病率和严重程度的数据主要限于病例报告和回顾性研究。这项对102名SARS-CoV-2 PCR阳性患者的前瞻性横断面研究调查了COVID-19患者神经系统受累（NIV）的频率、类型、严重程度和风险因素以及潜在的病理生理机制。在整个队列中，59.8%的患者患有NIV。非特异性NIV占24.5%，主要表现为全身无力、认知功能减退或谵妄。轻度NIV发生率为9.8%;最常见的是味觉或嗅觉受损。23.5%的患者存在严重的NIV，其中一半患有脑缺血。NIV的发病率随着COVID-19的呼吸道症状而增加。死亡率随NIV严重程度的增加而增加。值得注意的是，83.3%的重度NIV患者既存神经系统共病。所有脑脊液（CSF）样本均为SARS-CoV-2 RNA阴性，SARS-CoV-2抗体商未提示鞘内抗体合成。在重度NIV患者中，50%的患者有血脑屏障（BBB）破坏，并显示CSF中白细胞介素水平升高的趋势。在35%的受试患者中检测到针对神经元和神经胶质表位的抗体。脑血管事件是最常见的重度NIV，重度NIV与高死亡率相关。NIV的发病率随着呼吸道症状的增加而增加，NIV和预先存在的神经系统疾病是死亡的独立危险因素。由于BBB破坏和细胞因子释放导致的炎症参与驱动NIV，而不是直接的病毒入侵。这些发现可能有助于医生进一步确定在大流行期间需要特别关注的患者群体。
A growing number of reports suggest that infection with SARS-CoV-2 often leads to neurological involvement; however, data on the incidence and severity are limited to mainly case reports and retrospective studies. This prospective, cross-sectional study of 102 SARS-CoV-2 PCR positive patients investigated the frequency, type, severity and risk factors as well as underlying pathophysiological mechanisms of neurological involvement (NIV) in COVID-19 patients. Across the cohort, 59.8% of patients had NIV. Unspecific NIV was suffered by 24.5%, mainly general weakness and cognitive decline or delirium. Mild NIV was found in 9.8%; most commonly, impaired taste or smell. Severe NIV was present in 23.5%; half of these suffered cerebral ischaemia. Incidence of NIV increased with respiratory symptoms of COVID-19. Mortality was higher with increasing NIV severity. Notably, 83.3% with severe NIV had a pre-existing neurological co-morbidity. All cerebrospinal fluid (CSF) samples were negative for SARS-CoV-2 RNA, and SARS-CoV-2 antibody quotient did not suggest intrathecal antibody synthesis. Of the patients with severe NIV, 50% had blood–brain barrier (BBB) disruption and showed a trend of elevated interleukin levels in CSF. Antibodies against neuronal and glial epitopes were detected in 35% of the patients tested. Cerebrovascular events were the most frequent severe NIV and severe NIV was associated with high mortality. Incidence of NIV increased with respiratory symptoms and NIV and pre-existing neurological morbidities were independent risk factors for fatality. Inflammatory involvement due to BBB disruption and cytokine release drives NIV, rather than direct viral invasion. These findings might help physicians define a further patient group requiring particular attention during the pandemic.
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影响因子：
5
作者：
Desforges M;Le Coupanec A;Stodola JK;Meessen-Pinard M;Talbot PJ
通讯作者：
Talbot PJ
影响因子：
5.4
作者：
Arbour, N;Day, R;Talbot, PJ
通讯作者：
Talbot, PJ
DOI：
10.3233/jad-200581
发表时间：
2020
期刊：
Journal of Alzheimer's disease : JAD
影响因子：
--
作者：
Fotuhi M;Mian A;Meysami S;Raji CA
通讯作者：
Raji CA
影响因子：
11.8
作者：
Bellon, Mathilde;Schweblin, Cecilia;Deffert, Christine
通讯作者：
Deffert, Christine
DOI：
10.1016/j.ijantimicag.2020.105951
发表时间：
2020-05-01
影响因子：
10.8
作者：
Li, Heng;Liu, Shang-Ming;Tang, Chao-Ke
通讯作者：
Tang, Chao-Ke