儿童 SARS-CoV-2 相关脑病的临床特征：全国性流行病学研究。
Clinical characteristics of SARS-CoV-2-associated encephalopathy in children: Nationwide epidemiological study.
机构信息
Department of Brain and Neurosciences, Tokyo Metropolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, Japan.
Division of Neurology, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-ku, Tokyo, Japan.
出版信息
J Neurol Sci. 2024 Feb 15;457:122867. doi: 10.1016/j.jns.2024.122867. Epub 2024 Jan 3.
OBJECTIVE
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) sometimes triggers acute encephalopathy as a serious neurological complication in children. We previously reported the clinico-radiological findings of SARS-CoV-2-associated encephalopathy. The advent of the SARS-CoV-2 omicron variant led to a marked increase in pediatric patients with coronavirus disease 2019 (COVID-19); however, epidemiological changes with acute encephalopathy according to the emergence of SARS-CoV-2 have not yet been documented. Therefore, the present study investigated epidemiological differences in SARS-CoV-2-associated encephalopathy during the BA.1/BA.2 and BA.5 predominant periods and also between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
METHODS
We conducted a nationwide survey of SARS-CoV-2-associated encephalopathy in Japanese children between June and November 2022. We compared the present results during the BA.5 predominant period and previous findings during the BA.1/BA.2 predominant period. We also compared the clinico-radiological syndromes of encephalopathy between SARS-CoV-2-associated and non-SARS-CoV-2-associated encephalopathy.
RESULTS
Although many patients with SARS-CoV-2-associated encephalopathy in the BA.5 predominant period had seizures as their initial symptoms, no significant differences were observed in the clinical features. Patients with SARS-CoV-2-associated encephalopathy had worse outcomes than those with non-SARS-CoV-2-associated encephalopathy (p-value = 0.003). Among 103 patients with SARS-CoV-2-associated encephalopathy, 14 (13.6%) had severe types of acute encephalopathy, namely, encephalopathy with acute fulminant cerebral edema (AFCE) and hemorrhagic shock and encephalopathy syndrome (HSES). Also, 28 (27.2%) patients with SARS-CoV-2-associated encephalopathy had poor outcome: severe neurological sequelae or death. Ninety-five patients (92.2%) were not vaccinated against SARS-CoV-2.
CONCLUSIONS
In SARS-CoV-2-associated encephalopathy, high percentages of AFCE and HSES can result in poor outcomes.
目的
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）有时会引发急性脑病，作为儿童严重的神经系统并发症。我们之前报告了 SARS-CoV-2 相关脑病的临床放射学发现。SARS-CoV-2 奥密克戎变异株的出现导致儿童 2019 冠状病毒病（COVID-19）患者明显增加；然而，根据 SARS-CoV-2 的出现，急性脑病的流行病学变化尚未记录。因此，本研究调查了 BA.1/BA.2 和 BA.5 主导期间 SARS-CoV-2 相关脑病的流行病学差异，以及 SARS-CoV-2 相关和非 SARS-CoV-2 相关脑病之间的差异。
方法
我们对 2022 年 6 月至 11 月期间日本儿童 SARS-CoV-2 相关脑病进行了全国性调查。我们比较了 BA.5 主导期间的当前结果和 BA.1/BA.2 主导期间的先前结果。我们还比较了 SARS-CoV-2 相关和非 SARS-CoV-2 相关脑病的脑病临床放射学综合征。
结果
虽然 BA.5 主导期间许多 SARS-CoV-2 相关脑病患者以癫痫发作作为首发症状，但临床特征无显著差异。SARS-CoV-2 相关脑病患者的预后较非 SARS-CoV-2 相关脑病患者差（p 值=0.003）。在 103 例 SARS-CoV-2 相关脑病患者中，14 例（13.6%）为急性脑病严重型，即脑病伴急性暴发性脑水肿（AFCE）和出血性休克和脑病综合征（HSES）。此外，28 例（27.2%）SARS-CoV-2 相关脑病患者预后不良：严重神经后遗症或死亡。95 例（92.2%）患者未接种 SARS-CoV-2 疫苗。
结论
在 SARS-CoV-2 相关脑病中，高比例的 AFCE 和 HSES 可导致不良预后。
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