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新冠后出现神经系统症状和无神经系统症状患者的自主神经功能障碍:一项前瞻性多领域观察研究。

Autonomic dysfunction in post-COVID patients with and witfhout neurological symptoms: a prospective multidomain observational study.

机构信息

Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.

School of Medicine and Surgery, Department of Medicine, Surgery and Health Sciences, Trieste University Hospital-ASUGI, University of Trieste, Strada di Fiume, 447, 34149, Trieste, Italy.

出版信息

J Neurol. 2022 Feb;269(2):587-596. doi: 10.1007/s00415-021-10735-y. Epub 2021 Aug 12.


DOI:10.1007/s00415-021-10735-y
PMID:34386903
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8359764/
Abstract

The autonomic nervous system (ANS) can be affected by COVID-19, and dysautonomia may be a possible complication in post-COVID individuals. Orthostatic hypotension (OH) and postural tachycardia syndrome (POTS) have been suggested to be common after SARS-CoV-2 infection, but other components of ANS function may be also impaired. The Composite Autonomic Symptom Scale 31 (COMPASS-31) questionnaire is a simple and validated tool to assess dysautonomic symptoms. The aim of the present study was to administer the COMPASS-31 questionnaire to a sample of post-COVID patients with and without neurological complaints. Participants were recruited among the post-COVID ambulatory services for follow-up evaluation between 4 weeks and 9 months from COVID-19 symptoms onset. Participants were asked to complete the COMPASS-31 questionnaire referring to the period after COVID-19 disease. Heart rate and blood pressure were manually taken during an active stand test for OH and POTS diagnosis. One-hundred and eighty participants were included in the analysis (70.6% females, 51 ± 13 years), and OH was found in 13.8% of the subjects. Median COMPASS-31 score was 17.6 (6.9-31.4), with the most affected domains being orthostatic intolerance, sudomotor, gastrointestinal and pupillomotor dysfunction. A higher COMPASS-31 score was found in those with neurological symptoms (p < 0.01), due to more severe orthostatic intolerance symptoms (p < 0.01), although gastrointestinal (p < 0.01), urinary (p < 0.01), and pupillomotor (p < 0.01) domains were more represented in the non-neurological symptoms group. This study confirms the importance of monitoring ANS symptoms as a possible complication of COVID-19 disease that may persist in the post-acute period.

摘要

自主神经系统(ANS)可能会受到 COVID-19 的影响,而自主神经功能障碍可能是 COVID-19 后个体的一种潜在并发症。体位性低血压(OH)和姿势性心动过速综合征(POTS)在 SARS-CoV-2 感染后被认为很常见,但 ANS 功能的其他组成部分也可能受损。综合自主症状量表 31 项(COMPASS-31)问卷是一种评估自主神经症状的简单且经过验证的工具。本研究的目的是向有和无神经系统症状的 COVID-19 后患者样本中使用 COMPASS-31 问卷。参与者是在 COVID-19 症状出现后 4 周到 9 个月期间从 COVID-19 门诊服务中招募的,进行后续评估。参与者被要求在 COVID-19 疾病后填写 COMPASS-31 问卷。为了诊断 OH 和 POTS,在主动站立测试期间手动测量心率和血压。共有 180 名参与者被纳入分析(70.6%为女性,51±13 岁),13.8%的患者存在 OH。COMPASS-31 评分中位数为 17.6(6.9-31.4),受影响最严重的领域是直立不耐受、汗腺、胃肠道和瞳孔运动功能障碍。有神经系统症状的患者的 COMPASS-31 评分较高(p<0.01),这是由于更严重的直立不耐受症状(p<0.01),尽管胃肠道(p<0.01)、尿(p<0.01)和瞳孔运动(p<0.01)方面在无神经系统症状组中更为明显。本研究证实了监测自主神经系统症状作为 COVID-19 疾病的一种潜在并发症的重要性,这种症状可能会在急性后期持续存在。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd63/8782772/ab818a641b3d/415_2021_10735_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd63/8782772/a831771ba1fc/415_2021_10735_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd63/8782772/ab818a641b3d/415_2021_10735_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd63/8782772/a831771ba1fc/415_2021_10735_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/cd63/8782772/ab818a641b3d/415_2021_10735_Fig2_HTML.jpg

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[6]
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[7]
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[8]
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本文引用的文献

[1]
Machine learning based prediction models in male reproductive health: Development of a proof-of-concept model for Klinefelter Syndrome in azoospermic patients.

Andrology. 2022-3

[2]
The risk of delirium and falls or fractures with the use of overactive bladder anticholinergic medications.

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Front Neurol. 2021-4-13

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