Gong Siyin, Deng Bo, Yu Hai, Zhang Xiang, Yang Wenbo, Chen Xiangjun
Department of Neurology, Huashan Hospital, Fudan University and Institute of Neurology, Fudan University, National Center for Neurological Disorders, Shanghai, China.
Department of Neurological Diseases, The Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Front Immunol. 2024 Dec 18;15:1499082. doi: 10.3389/fimmu.2024.1499082. eCollection 2024.
This study aimed to present clinical and immunological features in patients with neuroimmune complications of COVID-19 during Omicron wave in China.
Patients with neuroimmune complications associated with COVID-19 were retrospectively analyzed in Huashan Hospital from December 2022 to April 2023, during the widespread prevalence of Omicron variants in China. Demographic information, symptoms, electrophysiological findings, cerebrospinal fluid(CSF) test results and immunological markers, Magnetic Resonance Imaging(MRI) characteristics, treatment strategies and outcomes of these patients were reviewed and analyzed.
A total of 53 cases of neuroimmune complications were included, with 7 cases of non-immune complications taken as controls. Neuroimmune complications comprised: 7 cases of Guillain-Barre syndrome/chronic inflammatory demyelinating polyneuropathy, 11 cases of spinal meningitis/myelitis, 2 cases of neuromyelitis optica spectrum disorder, 2 cases of myelin oligodendrocyte glycoprotein antibody-associated disease, 1 case of acute disseminated encephalomyelitis, 10 cases of autoimmune encephalitis, 17 cases of other encephalopathy/encephalitis and 3 cases of cerebellitis. SARS-CoV-2 was only detected in the CSF sample of one neuroimmune complications patient. CSF-restricted oligoclonal bands were detected in 11.1% (5/45) of neuroimmune patients, but absent in non-immune cases (0.0%, 0/5). Autoantibody testing identified specific antibodies in 26.5%(13/49) of neuroimmune cases and 0.0% (0/5) of non-immune cases. Glucocorticoids or intravenous immunoglobulins were administered as first-line treatments for all neuroimmune cases (100%, 53/53), whereas only 42.8% (3/7) of non-immune cases received these therapies. A baseline modified Rankin scale (mRS) score of 3 or above was present in the majority of both neuroimmune cases (96.2%, 51/53) and non-immune cases (71.4%, 5/7). At the end of a follow-up period, independent functional outcomes at day-90 with an mRS score below two were observed in a significant proportion of both neuroimmune cases (77.4%, 41/53) and non-immune case(71.4%, 5/7).
The manifestations of neuroimmune complications of COVID-19 are diverse and can manifest with severe neurological deficits early in the course of the disease. The detection of immunological markers (such as autoantibody and oligoclonal bands) and immunotherapies can help to improve the prognosis of COVID-19 related neuroimmune complications.
本研究旨在呈现中国奥密克戎毒株流行期间新冠病毒感染相关神经免疫并发症患者的临床和免疫学特征。
回顾性分析2022年12月至2023年4月在中国奥密克戎毒株广泛流行期间，于华山医院就诊的新冠病毒感染相关神经免疫并发症患者。收集这些患者的人口统计学信息、症状、电生理检查结果、脑脊液（CSF）检测结果及免疫标志物、磁共振成像（MRI）特征、治疗策略及预后情况，并进行分析。
共纳入53例神经免疫并发症患者，7例非免疫并发症患者作为对照。神经免疫并发症包括：7例吉兰-巴雷综合征/慢性炎症性脱髓鞘性多发性神经病、11例脊膜脑膜炎/脊髓炎、2例视神经脊髓炎谱系疾病、2例髓鞘少突胶质细胞糖蛋白抗体相关疾病、1例急性播散性脑脊髓炎、10例自身免疫性脑炎、17例其他脑病/脑炎及3例小脑炎。仅在1例神经免疫并发症患者的脑脊液样本中检测到严重急性呼吸综合征冠状病毒2（SARS-CoV-2）。11.1%（5/45）的神经免疫患者检测到脑脊液局限性寡克隆带，而非免疫患者未检测到（0.0%，0/5）。自身抗体检测在26.5%（13/49）的神经免疫病例中发现特异性抗体，非免疫病例中未发现（0.0%，0/5）。所有神经免疫病例（100%，53/53）均采用糖皮质激素或静脉注射免疫球蛋白作为一线治疗，而非免疫病例中仅42.8%（3/7）接受了这些治疗。大多数神经免疫病例（96.2%，51/53）和非免疫病例（71.4%，5/7）的改良Rankin量表（mRS）基线评分在3分及以上。随访期末，相当比例的神经免疫病例（77.4%，41/53）和非免疫病例（71.4%，5/7）在第90天的独立功能预后mRS评分低于2分。
新冠病毒感染相关神经免疫并发症表现多样，可在疾病早期出现严重神经功能缺损。免疫标志物（如自身抗体和寡克隆带）检测及免疫治疗有助于改善新冠病毒感染相关神经免疫并发症的预后。
