急性 COVID-19 脑病与季节性甲型流感相关脑病的比较

Pub Date : 2024-04-22 DOI:10.5812/ijp-142946
Jialu Xu, Wei Li, Yilin Zhu, Jiajin Wang, Haifeng Li
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引用次数: 0

摘要

目的比较急性冠状病毒病 2019(COVID-19)脑病和季节性甲型流感病毒(IAV)相关脑病患儿的临床表现和神经生物学特征。研究方法我们对浙江大学医学院附属儿童医院2022年12月15日至2023年1月15日期间诊断为COVID-19脑病的患者和2017年11月至2023年3月期间诊断为IAV相关性脑病的18岁以下儿童进行了回顾性队列研究。研究结果本研究共纳入34例COVID-19急性脑病患者和37例IAV相关性脑病患者。在 COVID-19 ICU 组和中重度组均观察到脑脊液(CSF)多形细胞和 CSF 葡萄糖升高,以及单核细胞和 TNF-α 下调。与 IAV 组相比,COVID-19 组患者的中位年龄更小(P < 0.001),出现神经症状的中位时间更短(P < 0.001)。IAV 组中有更多患者出现意识改变(P < 0.001)并被送入重症监护室(P < 0.001)。因此,IAV 组的重症病例也更多一些(P = 0.007)。脑成像显示,急性坏死性脑病主要出现在 IAV 组(P = 0.038)。血液参数方面,IAV 组白细胞水平较低(P = 0.003),CD4 表达较低(P = 0.047)。COVID-19组的随机血糖(P = 0.001)、D二聚体(P = 0.004)和细胞因子IL-2(P = 0.005)较低,而IFN-γ(P = 0.013)显著较高。结论甲型流感病毒相关脑病的表现更为严重。然而,IFN-γ在COVID-19脑病中可能是一种保护性细胞因子。
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Comparison of Acute COVID-19 Encephalopathy with Seasonal Influenza A-Associated Encephalopathy
Objectives: To compare the clinical presentations and neurobiological features in children with acute Coronavirus disease 2019 (COVID-19) encephalopathy and Seasonal influenza A virus (IAV)-associated encephalopathy. Methods: We conducted a retrospective cohort study on patients diagnosed with COVID-19 encephalopathy between December 15, 2022, and January 15, 2023, and children diagnosed with IAV-associated encephalopathy between November 2017 and March 2023, who were less than 18 years old at the Children’s Hospital, Zhejiang University School of Medicine. Results: A total of 34 patients with acute COVID-19 encephalopathy and 37 patients with IAV-associated encephalopathy were included in this study. Elevation of cerebrospinal fluid (CSF) pleocytosis and CSF glucose, as well as downregulation of monocyte and TNF-α, were observed in both the COVID-19 ICU group and the moderate & severe group. The median age was younger (P < 0.001) and the median time for the occurrence of neurological symptoms was shorter (P < 0.001) in the COVID-19 group compared with the IAV group. More patients in the IAV group had altered levels of consciousness (P < 0.001) and were admitted to the ICU (P < 0.001). Consequently, more severe cases were observed in the IAV group (P = 0.007). Brain imaging showed a predominance appearance of acute necrotizing encephalopathy in the IAV group (P = 0.038). Regarding blood parameters, leukomonocyte levels were lower in the IAV group (P = 0.003) with lower expression of CD4 (P = 0.047). Random blood glucose (P = 0.001), D dimer (P = 0.004), and cytokine IL-2 (P = 0.005) were lower in the COVID-19 group, while IFN-γ (P = 0.013) was significantly higher. Conclusions: Influenza A virus-associated encephalopathy presented more severe manifestations. However, IFN-γ may act as a protective cytokine in COVID-19 encephalopathy.
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