奥密克戎变异株相关儿童急性脑炎/脑病的危险因素。
Risk factors of Omicron variant associated acute encephalitis/encephalopathy in children.
机构信息
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan, Taiwan.
Department of Pediatrics, Chang Gung Children's Hospital, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan; Division of Pediatric Critical Care, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Pediatric Neurology, Department of Pediatrics, Chang Gung Children's Hospital and Chang Gung Memorial Hospital, Taoyuan, Taiwan.
出版信息
J Microbiol Immunol Infect. 2023 Dec;56(6):1169-1177. doi: 10.1016/j.jmii.2023.08.010. Epub 2023 Sep 4.
BACKGROUND
Outbreak of Omicron BA.2 in Taiwan led to an increased number of acute encephalitis/encephalopathy cases in children and several fatal cases drew public attention. In pre-Omicron period, pediatric cases of COVID-19-associated acute encephalitis have been reported and during Omicron epidemic, febrile convulsions, encephalitis were mentioned more frequently. The outcome of patients with neurological complications was worse. However, few studies investigated the risk factors, pathophysiology and prognosis of COVID-19-associated encephalitis/encephalopathy. Here, we describe the presentation of pediatric cases of COVID-19-associated acute encephalitis/encephalopathy and explore the associated risk factors.
METHODS
Pediatric patients with confirmed SARS-CoV-2 infections were prospectively enrolled at admission at Chang Gung Memorial Hospital between April and August 2022. Patients were categorized into groups of acute encephalitis/encephalopathy, febrile convulsions or mild disease. Demographic descriptions, clinical manifestations and laboratory data were collected.
RESULTS
Of 288 acute COVID-19 patients, there were 38 (13.2%) acute encephalitis/encephalopathy, 40 (13.9%) febrile convulsions, and 210 (72.9%) mild disease. Among acute encephalitis/encephalopathy group, the mean age was 68.3 ± 45.0 months. The common neurological symptoms were lethargy (65.8%), seizures (52.6%), and impaired consciousness (34.2%). Over 3 years old (adjusted odds ratio [aOR]: 7.57, p < 0.001), absolute neutrophil count ≥3150/μL (aOR: 5.46, p = 0.008), and procalcitonin ≥0.5 ng/mL (aOR: 4.32, p = 0.021) were independent factors for acute encephalitis/encephalopathy.
CONCLUSIONS
Most cases of COVID-19-associated acute encephalitis/encephalopathy showed no evidence of direct viral invasion but associations with older age, increased peripheral neutrophil, and serum procalcitonin. These findings may imply the neutrophil-mediated systemic inflammatory response plays an important role on central nerve system, leading to cerebral dysfunction.
背景
台湾奥密克戎 BA.2 爆发导致儿童急性脑炎/脑病病例增多，数例死亡病例引起公众关注。在奥密克戎出现之前，已有 COVID-19 相关急性脑炎的儿科病例报告，而在奥密克戎流行期间，热性惊厥、脑炎更为常见。神经并发症患者的预后更差。然而，很少有研究调查 COVID-19 相关脑炎/脑病的危险因素、发病机制和预后。在这里，我们描述了儿科 COVID-19 相关急性脑炎/脑病病例的表现，并探讨了相关危险因素。
方法
2022 年 4 月至 8 月，在长庚纪念医院入院时前瞻性招募了确诊 SARS-CoV-2 感染的儿科患者。患者分为急性脑炎/脑病、热性惊厥或轻症疾病组。收集人口统计学描述、临床表现和实验室数据。
结果
在 288 例急性 COVID-19 患者中，有 38 例（13.2%）急性脑炎/脑病、40 例（13.9%）热性惊厥和 210 例（72.9%）轻症疾病。急性脑炎/脑病组的平均年龄为 68.3±45.0 个月。常见的神经系统症状为嗜睡（65.8%）、癫痫发作（52.6%）和意识障碍（34.2%）。年龄大于 3 岁（调整优势比[aOR]：7.57，p<0.001）、绝对中性粒细胞计数≥3150/μL（aOR：5.46，p=0.008）和降钙素原≥0.5ng/mL（aOR：4.32，p=0.021）是急性脑炎/脑病的独立危险因素。
结论
大多数 COVID-19 相关急性脑炎/脑病病例无直接病毒侵袭证据，但与年龄较大、外周中性粒细胞增多和血清降钙素原升高有关。这些发现可能意味着中性粒细胞介导的全身炎症反应对中枢神经系统发挥重要作用，导致大脑功能障碍。
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