Eitner Lynn, Maier Christoph, Brinkmann Folke, Schlegtendal Anne, Knoke Leona, Enax-Krumova Elena, Lücke Thomas
Department of Neuropediatrics, University Children's Hospital, Ruhr University Bochum, Bochum, Germany.
University Children's Hospital, Ruhr University Bochum, Bochum, Germany.
Front Pediatr. 2022 Oct 3;10:977827. doi: 10.3389/fped.2022.977827. eCollection 2022.
Long-term neurological complaints after SARS-CoV-2 infection occur in 4-66% of children and adolescents. Controlled studies on the integrity of the peripheral nerve system are scarce. Therefore, we examined the somatosensory function in children and adolescents after SARS-CoV-2 infection in a case-control study compared with age-matched individuals.
Eighty-one subjects after SARS-CoV-2 infection ( = 44 female, 11.4 ± 3.5 years, = 75 SARS-CoV-2 seropositive, = 6 PCR positive during infection and SARS-CoV-2 seronegative at the time point of study inclusion, = 47 asymptomatic infection) were compared to 38 controls without SARS-CoV-2 infection (26 female, 10.3 ± 3.4 years, = 15 with other infection within last 6 months). After standardised interviews and neurological examinations, large fibre (tactile and vibration detection thresholds) and small fibre (cold and warm detection thresholds, paradoxical heat sensation) functions were assessed on both feet following a validated protocol. After z-transformation of all values, all participants were compared to published reference values regarding the number of abnormal results. Additionally, the mean for all sensory parameters values of both study groups were compared to an ideal healthy population (with -value 0 ± 1), as well as with each other, as previously described. Statistical analyses: -test, Chi-squared test, and binominal test.
None of the controls, but 27 of the 81 patients (33%, < 0.001) reported persistent complaints 2.7 ± 1.9 (0.8-8.5) months after SARS-CoV-2 infection, most often reduced exercise capacity (16%), fatigue (13%), pain (9%), or paraesthesia (6%). Reflex deficits or paresis were missing, but somatosensory profiles showed significantly increased detection thresholds for thermal (especially warm) and vibration stimuli compared to controls. Approximately 36% of the patients after SARS-CoV-2, but none of the controls revealed an abnormal sensory loss in at least one parameter ( < 0.01). Sensory loss was characterised in 26% by large and 12% by small fibre dysfunction, the latter appearing more frequently in children with prior symptomatic SARS-CoV-2 infection. Myalgia/paraesthesia was indicative of somatosensory dysfunction. In all eight re-examined children, the nerve function recovered after 2-4 months.
This study provides evidence that in a subgroup of children and adolescents previously infected with SARS-CoV-2, regardless of their complaints, the function of large or small nerve fibres is presumably reversibly impaired.
4%至66%的儿童和青少年在感染新型冠状病毒2（SARS-CoV-2）后会出现长期神经方面的不适。关于外周神经系统完整性的对照研究较少。因此，在一项病例对照研究中，我们将感染SARS-CoV-2后的儿童和青少年与年龄匹配的个体进行比较，以检查他们的躯体感觉功能。
81名感染SARS-CoV-2后的受试者（44名女性，年龄11.4±3.5岁；75名SARS-CoV-2血清学阳性，6名在感染期间PCR阳性且在纳入研究时间点SARS-CoV-2血清学阴性，47名无症状感染）与38名未感染SARS-CoV-2的对照者（26名女性，年龄10.3±3.4岁，15名在过去6个月内有其他感染）进行比较。在进行标准化访谈和神经学检查后，按照经过验证的方案评估双脚的大纤维功能（触觉和振动检测阈值）和小纤维功能（冷觉和温觉检测阈值、反常热感觉）。对所有数值进行z变换后，将所有参与者的异常结果数量与已发表的参考值进行比较。此外，如前所述，将两个研究组所有感觉参数值的均值与理想健康人群（均值为0±1）以及彼此进行比较。统计分析：t检验、卡方检验和二项式检验。
对照组中无人报告不适，但81名患者中有27名（33%，P<0.001）在感染SARS-CoV-2后2.7±1.9（0.8 - 8.5）个月报告有持续不适，最常见的是运动能力下降（16%）、疲劳（13%）、疼痛（9%）或感觉异常（6%）。未出现反射缺陷或麻痹，但与对照组相比，躯体感觉特征显示热刺激（尤其是温觉）和振动刺激的检测阈值显著升高。约36%的SARS-CoV-2感染后患者至少有一项参数出现异常感觉丧失，而对照组中无人出现（P<0.01）。感觉丧失中26%表现为大纤维功能障碍，12%表现为小纤维功能障碍，后者在先前有症状性SARS-CoV-2感染的儿童中更常见。肌痛/感觉异常提示躯体感觉功能障碍。在所有8名复查的儿童中，神经功能在2至4个月后恢复。
本研究提供了证据，表明在先前感染SARS-CoV-2的儿童和青少年亚组中，无论他们是否有不适，大神经纤维或小神经纤维的功能可能受到可逆性损害。
