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新型冠状病毒感染后神经系统后遗症的纵向评估。

Longitudinal evaluation of neurologic-post acute sequelae SARS-CoV-2 infection symptoms.

机构信息

Department of Neurosciences, University of California, San Diego, San Diego, California, USA.

Department of Neurology, Stanford Medicine, Stanford, California, USA.

出版信息

Ann Clin Transl Neurol. 2022 Jul;9(7):995-1010. doi: 10.1002/acn3.51578. Epub 2022 Jun 15.


DOI:10.1002/acn3.51578
PMID:35702954
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9268882/
Abstract

OBJECTIVE: To assess the initial features and evolution of neurologic Postacute Sequelae of SARS-CoV-2 infection (neuro-PASC) in patients with and without prior neurologic disease. METHODS: Participants with neurologic symptoms following acute SARS-CoV-2 infection were recruited from October 9, 2020 to October 11, 2021. Clinical data included a SARS-CoV-2 infection history, neurologic review of systems, neurologic exam, Montreal cognitive assessment (MoCA), and symptom-based self-reported surveys at baseline (conducted after acute infection) and 6-month follow-up assessments. RESULTS: Fifty-six participants (69% female, mean age 50 years, 29% with prior neurologic disease such as multiple sclerosis) were enrolled, of which 27 had completed the 6-month follow-up visit in this ongoing study. SARS-CoV-2 infection severity was largely described as mild (39.3%) or moderate (42.9%). At baseline, following acute infection, the most common neurologic symptoms were fatigue (89.3%) and headaches (80.4%). At the 6-month follow-up, memory impairment (68.8%) and decreased concentration (61.5%) were the most prevalent, though on average all symptoms showed a reduction in reported severity score at the follow-up. Complete symptom resolution was reported in 33.3% of participants by 6 months. From baseline to 6 months, average MoCA scores improved overall though 26.3% of participants' scores decreased. A syndrome consisting of tremor, ataxia, and cognitive dysfunction (PASC-TAC) was observed in 7.1% of patients. INTERPRETATION: Early in the neuro-PASC syndrome, fatigue and headache are the most commonly reported symptoms. At 6 months, memory impairment and decreased concentration were most prominent. Only one-third of participants had completed resolution of neuro-PASC at 6 months, although persistent symptoms trended toward improvement at follow-up.

摘要

目的:评估伴有和不伴有既往神经疾病的 SARS-CoV-2 感染后神经后遗症(neuro-PASC)患者的初始特征和演变。

方法:从 2020 年 10 月 9 日至 2021 年 10 月 11 日招募了急性 SARS-CoV-2 感染后出现神经症状的参与者。临床数据包括 SARS-CoV-2 感染史、神经系统回顾、神经系统检查、蒙特利尔认知评估(MoCA)以及基线时基于症状的自我报告调查(在急性感染后进行)和 6 个月随访评估。

结果:共有 56 名参与者(69%为女性,平均年龄 50 岁,29%有既往神经疾病,如多发性硬化症)入组,其中 27 名在这项正在进行的研究中完成了 6 个月的随访。SARS-CoV-2 感染的严重程度主要为轻度(39.3%)或中度(42.9%)。在基线时,急性感染后,最常见的神经症状是疲劳(89.3%)和头痛(80.4%)。在 6 个月的随访中,记忆障碍(68.8%)和注意力不集中(61.5%)最为常见,但平均而言,所有症状在随访时的严重程度评分均有所下降。在 6 个月时,33.3%的参与者报告完全缓解症状。从基线到 6 个月,MoCA 评分总体上有所提高,尽管有 26.3%的参与者的评分下降。7.1%的患者观察到震颤、共济失调和认知功能障碍(PASC-TAC)的综合征。

解释:在神经 PASC 综合征的早期,疲劳和头痛是最常见的症状。6 个月时,记忆障碍和注意力不集中最为突出。只有三分之一的参与者在 6 个月时完成了神经 PASC 的缓解,尽管持续性症状在随访时呈改善趋势。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33f1/9268882/df328a5fc675/ACN3-9-995-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33f1/9268882/170f7e16ed81/ACN3-9-995-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33f1/9268882/df328a5fc675/ACN3-9-995-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33f1/9268882/170f7e16ed81/ACN3-9-995-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/33f1/9268882/df328a5fc675/ACN3-9-995-g002.jpg

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本文引用的文献

[1]
Risk factors and abnormal cerebrospinal fluid associate with cognitive symptoms after mild COVID-19.

Ann Clin Transl Neurol. 2022-2

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APOE ε4 associates with increased risk of severe COVID-19, cerebral microhaemorrhages and post-COVID mental fatigue: a Finnish biobank, autopsy and clinical study.

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