摘要
目的 分析新型冠状病毒Omicron变异株相关严重神经系统并发症的临床和影像学特征,提升对该病的认识。方法 回顾分析2022年12月至2023年1月深圳市儿童医院PICU收治的17例COVID-19感染且有严重神经系统并发症患儿的临床及影像学数据。根据预后分为死亡组与生存组,定性资料组间对比采用卡方检验,定量资料采用t检验(正态分布)或秩和检验(偏态分布)。结果 死亡组10例,急性暴发性脑水肿(AFCE)5例、急性坏死性脑病(ANE)4例、脑炎1例;生存组7例,ANE 3例,脑炎4例。影像结果死亡组脑干受累比例明显高于生存组(P=0.009)。实验室检查结果,死亡组降钙素原(PCT)、白细胞介素6(IL-6)、丙氨酸转氨酶(ALT)、天门冬氨酸基转移酶(AST)、乳酸脱氢酶(LDH)、D-二聚体(D-D)、凝血酶时间(TT)、纤维蛋白原降解产物(FDP)均高于生存组(P<0.05)。死亡组并发脑疝、多器官功能障碍综合征(MODS)、心肌损伤、呼衰和弥散性血管内凝血(DIC)的比例明显高于生存组(P<0.05)。结论 儿童Omicron变异株相关严重神经系统并发症死亡率高,发热起病的儿童迅速出现抽搐、意识障碍,需高度警惕并发ANE和AFCE,延髓受累是AFCE的重要特点。
Objective To analyze the clinical characteristics and neuroimaging features of severe neurological complications associated with Omicron variant of COVID-19,aiming to improve the understanding of disease.Methods Clinical and imaging data of 17 patients with COVID-19 infection complicated with severe neurological complications from Shenzhen Children's Hospital from December 2022 to January 2023 were retrospectively analyzed.They were divided into death group and survival group according to the prognosis.Chi-square test was used for comparison between qualitative data groups,and t-test(normal distribution) or rank-sum test(skewed distribution) was used for quantitative data.Results In the death group,there were 10 cases,5 cases of acute fulminant cerebral edema(AFCE),4 cases of acute necrotizing encephalopathy(ANE) and 1 case of encephalitis.In the survival group,there were 7 cases,3 cases of ANE and 4 cases of encephalitis.The incidence of brain stem involvement in the death group was significantly higher than survival group(P=0.009).The results of laboratory examination showed that PCT,IL-6,ALT,AST,LDH,D-D,TT and FDP in the death group were higher than those in the survival group(P <0.05).The proportions of cerebral hernia,MODS,myocardial injury,respiratory failure and DIC in death group were significantly higher than those in survival group(P <0.05).Conclusion Omicron variant is associated with a high mortality rate of severe neurological complications in children.Children with febrile onset,rapidly convulsions and disturbance of consciousness,need to be on high alert for ANE and AFCE.Medulla involvement is an important characteristic of AFCE.
作者
徐淑敏
林洁琼
魏锋
谭伟婷
李鹏
杨卫国
曾洪武
XU Shumin;LIN Jieqiong;WEI Feng(Department of Radiology,Shenzhen Children's Hospital,Shenzhen,Guangdong Province 518038,P.R.China)
出处
《临床放射学杂志》
北大核心
2024年第3期431-437,共7页
Journal of Clinical Radiology
基金
深圳市医疗卫生三名工程资助项目(编号:SZSM202011005)
广东高水平医院专项经费资助项目(编号:ynkt2021-zz46)。
