SARS-CoV-2感染后新发中枢神经系统脱髓鞘疾病分析  

Analysis of Newly-onset Central Nervous System Demyelinating Disorders Following SARS-CoV-2 Infection

作　　者：占家炀 葛慧珍 桂梦翠 林婧 卜碧涛[1,2] ZHAN Jiayang;GE Huizhen;GUI Mengcui;LIN Jing;BU Bitao(Department of Neurology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Hubei Key Laboratory of Neural Injury and Functional Reconstruction,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院神经内科,武汉430030 [2]神经损伤与功能重建湖北省重点实验室,武汉430030

出　　处：《神经损伤与功能重建》2024年第12期711-714,745,共5页Neural Injury and Functional Reconstruction

摘　　要：目的:探索SARS-CoV-2感染后的中枢神经系统脱髓鞘疾病的临床特征。方法:选择2022年5月至2023年5月我科收治的新发中枢神经系统脱髓鞘患者57例。其中37例在发病前1个月内感染过SARS-CoV-2,纳入感染组;20例在发病前未感染过SARS-CoV-2,纳入对照组。收集2组临床资料、影像学资料进行比较分析,并进行为期1年的随访。结果:感染组SARS-CoV-2感染与中枢神经系统脱髓鞘病变发生的中位间隔时间为13(7,20)d。2组患者的部分脊髓症状和年化复发率存在差异;与对照组相比,感染组患者肢体瘫痪(22.1%vs16.7%,P<0.05)和大小便障碍(17.6%vs 5.6%,P<0.05)发生率较高(P<0.05),年化复发率较低[(0.00±0.35)vs(0.00±0.69),P<0.05];2组的其他临床症状、神经功能评分、免疫学指标、影像学病灶特征、电生理与眼科相关检查、短期预后差异均无统计学意义(P>0.05)。结论:SARS-CoV-2感染与中枢神经系统脱髓鞘的发生发展之间存在关联,但两者的因果关系尚未可知。感染与未感染SARS-CoV-2病毒的脱髓鞘患者的临床特征差异不大,仅部分脊髓症状和年化复发率存在一定差异。Objective:To investigate the clinical features of newly-onset central nervous system(CNS)demyelinating disorders post-SARS-CoV-2 infection.Methods:A total of 57 patients with newly diagnosed CNS demyelinating diseases admitted to our department from May 2022 to May 2023 were studied.Among these,37 individuals who contracted SARS-CoV-2 within a month preceding symptom onset constituted the infection group;meanwhile,20 patients without prior SARS-CoV-2 exposure formed the control group.Clinical and radiological records of both groups were gathered for comparative assessment,followed by a year-long surveillance.Results:The median time span between SARS-CoV-2 infection and the manifestation of CNS demyelination in the infected group was 13(7,20)days.Disparities were observed in specific spinal manifestations and annual recurrence rates(ARR)between the groups;specifically,the infection group exhibited elevated frequencies of limb paralysis(22.1%vs 16.7%,P<0.05)and disturbances in bladder and bowel function(17.6%vs 5.6%,P<0.05)relative to controls(P<0.05),along with a reduced ARR[(0.00±0.35)vs(0.00±0.69),P<0.05];conversely,no statistically significant disparities emerged in other clinical presentations,neurological evaluations,immunological markers,imaging characteristics,electrophysiological studies,ophthalmological tests,or short-term prognoses across the two groups(P>0.05).Conclusion:While an association exists between SARS-CoV-2 infection and the emergence of CNS demyelinating conditions,the causal link remains undetermined.Clinically,demyelinating patients with and without SARS-CoV-2 infection largely share similar profiles,save for select spinal symptoms and variations in ARR.

关 键 词：中枢神经系统 脱髓鞘 严重急性呼吸道综合征冠状病毒2 

分 类 号：R741[医药卫生—神经病学与精神病学] R741.02[医药卫生—临床医学] R742