背景:疲劳是2019年冠状病毒病(COVID-19)感染后报告的最常见的神经系统症状之一。为了建立有效的早期干预策略,应更加强调疲劳与皮质神经生理变化之间的相关性,尤其是在医护人员中,感染COVID-19的风险更高。
方法:进行了一项前瞻性队列研究,纳入29名COVID-19医务工作者和24名健康对照者。评估包括疲劳,睡眠和健康质量,心理状态,和物理能力。使用功能近红外光谱(fNIRS)检测大脑区域的激活。使用单脉冲和成对脉冲经颅磁刺激测量双侧初级运动皮层(M1)的兴奋性。在病程的1、3和6个月评估结果。
结果:感染COVID-19后1个月,37.9%的患者出现严重的疲劳症状,3个月时下降到10.3%。有趣的是,双侧前额叶(PFC)和M1的激活/兴奋性显着下降与COVID-19后的疲劳症状密切相关。值得注意的是,M1区兴奋性的增加与疲劳改善更显著相关。与单一感染患者相比,再感染患者的大脑激活和兴奋性水平较低。
结论:COVID-19的单次感染和再感染均导致PFC和M1的激活和兴奋性降低。M1区域中的兴奋性改善程度与更大的疲劳恢复相关。基于这些发现,提高和调节M1兴奋性的针对性干预措施可能是COVID-19早期康复的新策略。
背景:西京医院伦理审查委员会,不。KY20232051-F-1;www.chictr.org.cn,ChiCTR2300068444。
BACKGROUND: Fatigue is one of the most common neurological symptoms reported post coronavirus disease 2019 (COVID-19) infection. In order to establish effective early intervention strategies, more emphasis should be placed on the correlation between fatigue and cortical neurophysiological changes, especially in healthcare workers, who are at a heightened risk of COVID-19 infection.
METHODS: A prospective cohort study was conducted involving 29 COVID-19 medical workers and 24 healthy controls. The assessment included fatigue, sleep and health quality, psychological status, and physical capacity. Functional near-infrared spectroscopy (fNIRS) was employed to detect activation of brain regions. Bilateral primary motor cortex (M1) excitabilities were measured using single- and paired-pulse transcranial magnetic stimulation. Outcomes were assessed at 1, 3, and 6 months into the disease course.
RESULTS: At 1-month post-COVID-19 infection, 37.9% of patients experienced severe fatigue symptoms, dropping to 10.3% at 3 months. Interestingly, the remarkable decreased activation/excitability of bilateral prefrontal lobe (PFC) and M1 were closely linked to fatigue symptoms after COVID-19. Notably, greater increase in M1 region excitability correlated with more significant fatigue improvement. Re-infected patients exhibited lower levels of brain activation and excitability compared to single-infection patients.
CONCLUSIONS: Both single infection and reinfection of COVID-19 lead to decreased activation and excitability of the PFC and M1. The degree of excitability improvement in the M1 region correlates with a greater recovery in fatigue. Based on these findings, targeted interventions to enhance and regulate the excitability of M1 may represent a novel strategy for COVID-19 early rehabilitation.
BACKGROUND: The Ethics Review Committee of Xijing Hospital, No. KY20232051-F-1; www.chictr.org.cn , ChiCTR2300068444.