Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review.
Cerebrospinal fluid analysis in patients with COVID-19-associated central nervous system manifestations: a systematic review.
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DOI：
10.1590/0004-282x-anp-2021-0117
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发表时间：
2022-03
影响因子：
1.4
通讯作者：
Senne, Carlos
中科院分区：
文献类型：
--
作者：
Domingues, Renan Barros;Vilela de Moura Leite, Fernando Brunale;Senne, Carlos
急性COVID-19患者可能出现中枢神经系统（CNS）症状。CSF检查在这些患者中的作用仍有待确定。对与COVID-19相关的CSF结果进行了系统性审查。在急性COVID-19和以下CNS综合征之一的患者中记录和分析CSF参数，包括细胞学和生化分析、SARS-CoV-2 RT-PCR和其他CSF标志物：中风、脑病、脑炎、炎性综合征、癫痫发作、头痛和脑膜炎。52.7%的脑炎、29.4%的脑病和46.7%的炎性综合征患者出现白色细胞增多和/或蛋白浓度增高（P < 0.05）。脑脊液SARS-CoV-2 RT-PCR阳性率在脑炎组为17.35%，在脑病或炎性综合征组低于3.5%（P < 0.05）。鞘内免疫球蛋白的生产被发现在只有8%的情况下。超过85%的患者CSF细胞因子和趋化因子升高。71%和36%的病例分别发现CSF神经丝轻链（NfL）和CSF Tau增加。在COVID-19 CNS综合征患者中经常发现非特异性炎性CSF异常。神经变性生物标志物的增加表明发生了神经元损伤，其长期后果仍然未知。
Central nervous system (CNS) symptoms may occur in patients with acute COVID-19. The role of CSF examination in these patients remains to be established. A systematic review of CSF findings relating to COVID-19 was carried out. CSF parameters, including cytological and biochemical analyses, SARS-CoV-2 RT-PCR and other CSF markers, were recorded and analyzed among patients with acute COVID-19 and one of the following CNS syndromes: stroke, encephalopathy, encephalitis, inflammatory syndromes, seizure, headache and meningitis. Increased white blood cells and/or increased protein concentration were found in 52.7% of the patients with encephalitis, 29.4% of the patients with encephalopathy and 46.7% of the patients with inflammatory syndromes (P < 0.05). CSF RT-PCR for SARS-CoV-2 was positive in 17.35% of the patients with encephalitis and less than 3.5% of the patients with encephalopathy or inflammatory syndromes (P < 0.05). Intrathecal production of immunoglobulins was found in only 8% of the cases. More than 85% of the patients had increased CSF cytokines and chemokines. Increased CSF neurofilament light chain (NfL) and CSF Tau were found in 71% and 36% of the cases, respectively. Non-specific inflammatory CSF abnormalities were frequently found in patients with COVID-19 CNS syndromes. The increase in neurodegeneration biomarkers suggests that neuronal damage occurs, with long-term consequences that are still unknown.