Li Dan, Wang Qiang, Jia Chengyou, Lv Zhongwei, Yang Jianshe
Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, 200072, People's Republic of China.
Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, People's Republic of China.
J Inflamm Res. 2022 Jul 26;15:4199-4215. doi: 10.2147/JIR.S375494. eCollection 2022.
The coronavirus disease 2019 (COVID-19), induced by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a multi-organ and multi-system disease with high morbidity and mortality in severe cases due to respiratory failure and severe cardiovascular events. However, the various manifestations of neurological and psychiatric (N/P) systems of COVID-19 should not be neglected. Some clinical studies have reported a high risk of N/P disorders in COVID-19 and post-COVID-19 patients and that their outcomes were positively associated with the disease severity. These clinical manifestations could attribute to direct SARS-CoV-2 invasion into the central nervous system (CNS), which is often complicated by systemic hypoxia, the dysfunctional activity of the renin-angiotensin system and other relevant pathological changes. These changes may remain long term and may even lead to persistent post-COVID consequences on the CNS, such as memory, attention and focus issues, persistent headaches, lingering loss of smell and taste, enduring muscle aches and chronic fatigue. Mild confusion and coma are serious adverse outcomes of neuropathological manifestations in COVID-19 patients, which could be diversiform and vary at different stages of the clinical course. Although lab investigations and neuro-imaging findings may help quantify the disease's risk, progress and prognosis, large-scale and persistent multicenter clinical cohort studies are needed to evaluate the impact of COVID-19 on the N/P systems. However, we used "Boolean Operators" to search for relevant research articles, reviews and clinical trials from PubMed and the ClinicalTrials dataset for "COVID-19 sequelae of N/P systems during post-COVID periods" with the time frame from December 2019 to April 2022, only found 42 in 254,716 COVID-19-related articles and 2 of 7931 clinical trials involved N/P sequelae during post-COVID periods. Due to the increasing number of infected cases and the incessant mutation characteristics of this virus, diagnostic and therapeutic guidelines for N/P manifestations should be further refined.
2019冠状病毒病（COVID-19）由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起，是一种多器官、多系统疾病，严重时可因呼吸衰竭和严重心血管事件导致高发病率和死亡率。然而，COVID-19神经和精神（N/P）系统的各种表现不容忽视。一些临床研究报告称，COVID-19患者和COVID-19康复患者发生N/P障碍的风险较高，且其结果与疾病严重程度呈正相关。这些临床表现可能归因于SARS-CoV-2直接侵入中枢神经系统（CNS），常伴有全身缺氧、肾素-血管紧张素系统功能失调及其他相关病理变化。这些变化可能长期存在，甚至可能导致COVID-19后CNS出现持续性后果，如记忆、注意力和专注力问题、持续性头痛、嗅觉和味觉长期丧失、持续性肌肉疼痛和慢性疲劳。轻度意识模糊和昏迷是COVID-19患者神经病理表现的严重不良后果，在临床病程的不同阶段可能多种多样且有所不同。尽管实验室检查和神经影像学结果可能有助于量化疾病的风险、进展和预后，但仍需要大规模、持续的多中心临床队列研究来评估COVID-19对N/P系统的影响。然而，我们使用“布尔运算符”在PubMed和ClinicalTrials数据集中搜索2019年12月至2022年4月期间“COVID-19后时期N/P系统后遗症”的相关研究文章、综述和临床试验，在254716篇与COVID-19相关的文章中仅发现42篇，在7931项临床试验中有2项涉及COVID-19后时期的N/P后遗症。由于感染病例不断增加以及该病毒持续变异的特点，N/P表现的诊断和治疗指南应进一步完善。
