SARS-CoV-2感染相关脑炎的临床特点
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泰安市科技发展项目(2021NS287)


Clinical characteristics of SARS-CoV-2 infection-related encephalitis
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    摘要:

    目的 总结严重急性呼吸综合征冠状病毒2(SARS-CoV-2)感染相关脑炎的临床特点及其发病机制,旨在为临床诊治提供新的理论依据。方法 分析山东第一医科大学第二附属医院收治的25例SARS-CoV-2感染相关脑炎患者的临床特点及诊治过程,并探讨其发病机制。结果 前驱症状主要为发热(80.0%),首发症状主要为意识障碍(56.0%)、癫痫发作(52.0%)、精神症状(36.0%),后发症状主要为自主神经功能障碍(88.0%)、癫痫发作(68.0%)、认知功能障碍(68.0%)、运动障碍(64.0%)、语言功能障碍(52.0%)。辅助检查主要为脑脊液(CSF)蛋白定量增高、C反应蛋白(CRP)升高;脑电图(EEG)呈非特异性背景节律减慢,其次为异常放电;磁共振成像(MRI)最常表现为岛叶皮质、内侧颞叶异常高信号,其次为弥漫性或局灶性微出血。治疗上一线药物为糖皮质激素合并免疫疗法,二线药物为单抗。预后较差。结论 对于有SARS-CoV-2感染接触史、意识障碍、癫痫发作及精神症状的患者,应警惕脑炎可能,辅助CSF、EEG、MRI检查,一旦确诊及早干预。发病机制主要为直接侵袭、细胞因子风暴、过度免疫炎性、特异性T淋巴细胞反应等。

    Abstract:

    Objective To summarize the clinical characteristics and pathogenesis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection-related encephalitis, aiming to provide new theoretical basis for clinical diagnosis and treatment. Methods Clinical characteristics as well as diagnosis and treatment process of 25 patients with SARS-CoV-2 infection-related encephalitis in the Second Affiliated Hospital of Shandong First Medical University were analyzed, and the pathogenesis was evaluated. Results The main prodromal symptoms were fever (80.0%), the initial symptoms were consciousness disturbance (56.0%), epileptic seizures (52.0%), and mental symptoms (36.0%). The subsequent symptoms were mainly autonomic nerve dysfunction (88.0%), epileptic seizures (68.0%), cognitive dysfunction (68.0%), motor impairment (64.0%), and language dysfunction (52.0%). The auxiliary examination results were mainly increase of content of cerebrospinal fluid (CSF) protein and increase of C-reactive protein (CRP); electroencephalogram (EEG) showed slowing down of a non-specific background rhythm, followed by abnormal discharges; the most common manifestation of magnetic resonance imaging (MRI) was abnormal high signal in the insular cortex and medial temporal lobe, followed by diffuse or focal microbleeds. The first-line treatment agents were glucocorticoid combined with immunotherapy, and the second-line treatment agent was monoclonal antibody. The prognosis was poor. Conclusion Patients with a history of exposure to SARS-CoV-2 infection, consciousness disturbance, epileptic seizures and mental symptoms should be vigilant to the possibility of encephalitis. CSF, EEG, and MRI auxiliary examination should be given. Once diagnosed, early intervention is necessary. The main pathogenesis include direct invasion, cytokine storm, excessive immune inflammation, specific lymphocyte response, etc.

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高敏,袁慧. SARS-CoV-2感染相关脑炎的临床特点[J]. 中国感染控制杂志,2025,24(3):388-395. DOI:10.12138/j. issn.1671-9638.20256672.
GAO Min, YUAN Hui. Clinical characteristics of SARS-CoV-2 infection-related encephalitis[J]. Chin J Infect Control, 2025,24(3):388-395. DOI:10.12138/j. issn.1671-9638.20256672.

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  • 收稿日期:2024-06-27
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  • 在线发布日期: 2025-03-26
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