■越来越多的证据支持SARS-CoV-2可能的神经入侵潜力。然而,没有进行研究以探讨感染后中枢神经系统的微观结构变化的存在。我们旨在确定与SARS-CoV-2相关的潜在脑微结构变化的存在。
■在这项前瞻性研究中,在60例恢复的COVID-19患者(56.67%,男性;年龄:44.10±16.00)和39例年龄和性别匹配的非COVID-19对照(56.41%,男性;年龄:45.88±13.90)中,获得了扩散张量成像(DTI)和3D高分辨率T1WI序列.注册分数各向异性(FA),平均扩散率(MD),轴向扩散率(AD),和径向扩散率(RD)被量化为DTI,并引入了指标评分系统。使用协方差分析(ANCOVA)比较了基于体素的形态测量(VBM)和DTI指标得出的区域体积。采用双样本t检验和Spearman相关性评估影像学指标之间的关系。指标评分和临床信息。
■在这个后续阶段,55%COVID-19患者出现神经系统症状。COVID-19患者嗅觉皮层双侧灰质体积(GMV)显著高于统计学,海马,insolas,左罗兰迪克管罩,左Heschl回和右扣带回,MD总体下降,AD,RD伴有白质FA的增加,尤其是正确CR中的AD,EC和SFF,SFF和MD与非COVID-19志愿者相比(校正p值<0.05)。全球GMV,左罗兰迪克管壳中的GMV,右扣带回,双侧海马,左赫施尔回,发现WM的全局MD与记忆丧失相关(p值<0.05)。右侧扣带回和左侧海马的GMV与嗅觉丧失有关(p值<0.05)。MD-GM评分,全球GMV,右扣带回GMV与LDH水平相关(p值<0.05)。
研究结果表明,在COVID-19的恢复阶段,可能会破坏大脑的微观结构和功能完整性,这表明SARS-CoV-2的长期后果。
■上海市自然科学基金,国家自然科学基金青年计划,上海帆船项目,上海科技发展,上海市科技重大专项和ZJ实验室.
BACKGROUND: Increasing evidence supported the possible neuro-invasion potential of SARS-CoV-2. However, no studies were conducted to explore the existence of the micro-structural changes in the central nervous system after infection. We aimed to identify the existence of potential brain micro-structural changes related to SARS-CoV-2.
METHODS: In this prospective study, diffusion tensor imaging (DTI) and 3D high-resolution T1WI sequences were acquired in 60 recovered COVID-19 patients (56.67% male; age: 44.10 ± 16.00) and 39 age- and sex-matched non-COVID-19 controls (56.41% male; age: 45.88 ± 13.90). Registered fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were quantified for DTI, and an index score system was introduced. Regional volumes derived from Voxel-based Morphometry (VBM) and DTI metrics were compared using analysis of covariance (ANCOVA). Two sample t-test and Spearman correlation were conducted to assess the relationships among imaging indices, index scores and clinical information.
RESULTS: In this follow-up stage, neurological symptoms were presented in 55% COVID-19 patients. COVID-19 patients had statistically significantly higher bilateral gray matter volumes (GMV) in olfactory cortices, hippocampi, insulas, left Rolandic operculum, left Heschl\'s gyrus and right cingulate gyrus and a general decline of MD, AD, RD accompanied with an increase of FA in white matter, especially AD in the right CR, EC and SFF, and MD in SFF compared with non-COVID-19 volunteers (corrected p value <0.05). Global GMV, GMVs in left Rolandic operculum, right cingulate, bilateral hippocampi, left Heschl\'s gyrus, and Global MD of WM were found to correlate with memory loss (p value <0.05). GMVs in the right cingulate gyrus and left hippocampus were related to smell loss (p value <0.05). MD-GM score, global GMV, and GMV in right cingulate gyrus were correlated with LDH level (p value <0.05).
CONCLUSIONS: Study findings revealed possible disruption to micro-structural and functional brain integrity in the recovery stages of COVID-19, suggesting the long-term consequences of SARS-CoV-2.
BACKGROUND: Shanghai Natural Science Foundation, Youth Program of National Natural Science Foundation of China, Shanghai Sailing Program, Shanghai Science and Technology Development, Shanghai Municipal Science and Technology Major Project and ZJ Lab.