Knoke Leona, Schlegtendal Anne, Maier Christoph, Eitner Lynn, Lücke Thomas, Brinkmann Folke
University Children's Hospital, Ruhr University Bochum, Bochum, Germany.
Front Pediatr. 2022 Apr 25;10:851008. doi: 10.3389/fped.2022.851008. eCollection 2022.
Persistent respiratory symptoms after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in adults are frequent, and there can be long-term impairment of pulmonary function. To date, only preliminary evidence is available on persistent respiratory sequelae of SARS-CoV-2 in children and adolescents. Our objective was to examine the long-term effects of symptomatic and asymptomatic SARS-CoV-2 infections on pulmonary function in this age group in a single-center, controlled, prospective study.
Participants with serological or polymerase chain reaction-based evidence of SARS-CoV-2 infection were recruited from a population-based study of seroconversion rates. Multiple-breath washout (MBW), body plethysmography, and diffusion capacity testing were performed for children and adolescents. Participants were interviewed about their symptoms during the acute phase of infection and long-lasting symptoms. Cases were compared with SARS-CoV-2 seronegative controls from the same population-based study with and without history of respiratory infection within 6 months prior to assessment. Primary endpoints were differences in pulmonary function, including diffusion capacity and MBW, between participants with and without evidence of SARS-CoV-2 infection. Secondary endpoints included correlation between lung function and long-lasting symptoms as well as disease severity.
In total, 73 seropositive children and adolescents (5-18 years) were recruited after an average of 2.6 months (range 0.4-6.0) following SARS-CoV-2 infection. Among 19 patients (27.1%) who complained of persistent or newly emerged symptoms since SARS-CoV-2, 8 (11.4%) reported respiratory symptoms. No significant differences were detected in frequency of abnormal pulmonary function when comparing cases with 45 controls, including 14 (31.1%) with a history of previous infection (SARS-CoV-2: 12, 16.4%; controls: 12, 27.7%; odds ratio 0.54, 95% confidence interval 0.22-1.34). Only two patients with persistent respiratory symptoms showed abnormal pulmonary function. Multivariate analysis revealed reduced forced vital capacity ( = 0.012) in patients with severe SARS-CoV-2 infection.
Pulmonary function is rarely impaired in children and adolescents after SARS-CoV-2 infection, except from those with severe infection, and did not differ between SARS-CoV-2 and other previous infections, suggesting that SARS-CoV-2 is not more likely to cause pulmonary sequelae than other infections. The discrepancy between persisting respiratory symptoms and normal pulmonary function suggests a different underlying pathology such as dysfunctional breathing.
成人感染严重急性呼吸综合征冠状病毒2（SARS-CoV-2）后持续出现呼吸道症状很常见，并且可能存在肺功能的长期损害。迄今为止，关于儿童和青少年SARS-CoV-2持续呼吸道后遗症仅有初步证据。我们的目的是在一项单中心、对照、前瞻性研究中，探讨有症状和无症状SARS-CoV-2感染对该年龄组肺功能的长期影响。
从一项基于人群的血清转化率研究中招募有SARS-CoV-2感染血清学或基于聚合酶链反应证据的参与者。对儿童和青少年进行多次呼吸冲洗（MBW）、体容积描记法和弥散功能测试。就感染急性期的症状和持久症状对参与者进行访谈。将病例与来自同一基于人群研究的SARS-CoV-2血清阴性对照进行比较，对照在评估前6个月内有无呼吸道感染史。主要终点是有和无SARS-CoV-2感染证据的参与者之间肺功能的差异，包括弥散功能和MBW。次要终点包括肺功能与持久症状以及疾病严重程度之间的相关性。
总共招募了73名血清阳性儿童和青少年（5 - 18岁），平均在SARS-CoV-2感染后2.6个月（范围0.4 - 6.0个月）。在19名自SARS-CoV-2感染后抱怨有持续或新出现症状的患者中（27.1%），8名（11.4%）报告有呼吸道症状。将病例与45名对照进行比较时，在肺功能异常频率方面未检测到显著差异，其中14名（31.1%）有既往感染史（SARS-CoV-2组：12名，16.4%；对照组：12名，27.7%；比值比0.54，95%置信区间0.22 - 1.34）。仅有两名有持续呼吸道症状的患者肺功能异常。多变量分析显示严重SARS-CoV-2感染患者的用力肺活量降低（P = 0.012）。
SARS-CoV-2感染后儿童和青少年的肺功能很少受损，严重感染患者除外，且SARS-CoV-2感染与其他既往感染之间无差异，这表明SARS-CoV-2并不比其他感染更易导致肺部后遗症。持续呼吸道症状与正常肺功能之间的差异提示存在不同的潜在病理机制，如呼吸功能障碍。
