Uher Tomas, Stastna Dominika, Menkyova Ingrid, Capek Vaclav, Lindner Jiri, Nytrova Petra, Krasensky Jan, Varju Eliza, D'haeseleer Miguel, Havrdova Eva Kubala, Horakova Dana, Vaneckova Manuela, Bergsland Niels
Department of Neurology and Centre of Clinical Neuroscience, First Faculty of Medicine, Charles University in Prague and General University Hospital, Prague, Czechia.
Department of Neurology, Faculty of Medicine, Slovak Medical University, Bratislava, Slovakia.
Ann Clin Transl Neurol. 2025 Aug;12(8):1548-1555. doi: 10.1002/acn3.70091. Epub 2025 May 29.
The impact of SARS-CoV-2 infection on brain and spinal cord pathology in patients with multiple sclerosis (pwMS) remains unclear. We aimed to describe changes in brain lesion activity and brain and spinal cord volumes following SARS-CoV-2 infection.
We included 177 pwMS (570 MRI scans) diagnosed with and tested positive for SARS-CoV-2 infection between August 2020 and May 2021. All patients were free of clinical disease activity, disease-modifying therapy changes, and corticosteroids during the study. MRI scans were performed using a standardized protocol on a 3-Tesla scanner. We analyzed the effect of SARS-CoV-2 on brain lesion load accrual and brain and spinal cord volume measures using adjusted mixed-effect models.
During SARS-CoV-2 infection, patients had a median disease duration of 14.2 years, a median age of 44.9 years, and a median Expanded Disability Status Scale of 2.0. SARS-CoV-2 infection did not lead to any changes in the number or volume of T1 or T2 lesions in the brain. However, SARS-CoV-2 was associated with an increased whole brain (B = -0.17; SE = 0.08; p = 0.028), grey matter (B = -0.25; SE = 0.12; p = 0.040), and cortical grey matter volume loss (B = -0.32; SE = 0.13; p = 0.014). Greater ventricular enlargement following SARS-CoV-2 infection was evident only in individuals over the age of 40 (interaction of age vs. ventricular enlargement: B = 0.17; SE = 0.05; p = 0.0003). Only patients with more severe SARS-CoV-2 infection showed a reduction in mean upper cervical cord area (MUCCA) (B = 1.14; SE = 0.52; p = 0.030).
SARS-CoV-2 infection in clinically stable pwMS was linked to increased neuronal tissue loss.
严重急性呼吸综合征冠状病毒2（SARS-CoV-2）感染对多发性硬化症患者（pwMS）脑和脊髓病理的影响仍不清楚。我们旨在描述SARS-CoV-2感染后脑病变活动以及脑和脊髓体积的变化。
我们纳入了2020年8月至2021年5月期间诊断为SARS-CoV-2感染且检测呈阳性的177例pwMS患者（570次磁共振成像扫描）。在研究期间，所有患者均无临床疾病活动、疾病修饰治疗改变及使用皮质类固醇。使用标准化方案在3特斯拉扫描仪上进行磁共振成像扫描。我们使用调整后的混合效应模型分析SARS-CoV-2对脑病变负荷累积以及脑和脊髓体积测量的影响。
在SARS-CoV-2感染期间，患者的疾病持续时间中位数为14.2年，年龄中位数为44.9岁，扩展残疾状态量表中位数为2.0。SARS-CoV-2感染未导致脑内T1或T2病变数量或体积发生任何变化。然而，SARS-CoV-2与全脑体积减少（B=-0.17；标准误=0.08；p=0.028）、灰质体积减少（B=-0.25；标准误=0.12；p=0.040）以及皮质灰质体积减少（B=-0.32；标准误=0.13；p=0.014）相关。仅在40岁以上个体中，SARS-CoV-2感染后脑室扩大更为明显（年龄与脑室扩大的交互作用：B=0.17；标准误=0.05；p=0.0003）。仅SARS-CoV-2感染更严重的患者显示平均上颈髓面积（MUCCA）减少（B=1.14；标准误=0.52；p=0.030）。
临床稳定的pwMS患者感染SARS-CoV-2与神经元组织损失增加有关。
