目的:严重急性呼吸综合征冠状病毒2(SARS-CoV-2)引起急性坏死性脑病(ANE),死亡率高,后遗症严重。本研究旨在早期识别ANE并评估托珠单抗在ANE治疗中的有效性。
方法:我们回顾性地纳入了西安市儿童医院感染SARS-CoV-2的8例儿科ANE病例,中国,从2022年12月1日至2023年5月1日。使用PUBMED进行文献检索,弹簧,Scopus,EMBASE数据库。这项研究包括11名患者。临床特征,实验室测试结果,成像特征,并分析了治疗方案。
结果:19例中有8例(42%)死亡,一个(5%)恢复,和9(47%)改善与残余的神经功能障碍。十八名病人出现发烧,56%的温度≥40°C。12例患者(63%)出现意识障碍。八名(42%)患者经历了频繁的抽搐。我院所有8例患者的降钙素原水平均升高(平均:21.32ng/mL,范围:0.10-89.40纳克/毫升)。丙氨酸转氨酶水平升高(平均值:632.81U/L,范围:13.00-2251.00U/L)6例。7例患者显示尿酸水平升高(平均:396.50μmol/L,范围:157.00-660.00μmol/L)。脑成像显示所有患者双侧丘脑均有对称性损伤,伴随着大脑的对称损伤,小脑,基底神经节,和脑干。与经典治疗(n=9)相比,托珠单抗联合治疗(n=6)在死亡率方面有统计学差异(p=0.028<0.05).
结论:SARS-CoV-2感染患儿ANE的典型临床表现为急性起病伴高热,频繁的抽搐和迅速恶化的意识障碍。Tocilizumab治疗可以降低ANE的死亡率。
OBJECTIVE: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes acute necrotizing encephalopathy (ANE), which has a high mortality rate and severe sequelae. This study aimed to identify ANE early and evaluate the usefulness of tocilizumab in ANE treatment.
METHODS: We retrospectively included eight paeefediatric ANE cases infected with SARS-CoV-2 at Xi\'an Children\'s Hospital, China, from December 1, 2022 to May 1, 2023. A literature search was performed using the PUBMED, SPRING, SCOPUS, and EMBASE databases. This study included eleven patients. Clinical characteristics, laboratory test results, imaging features, and treatment options were analysed.
RESULTS: Eight of the 19 cases (42 %) died, one (5 %) recovered, and nine (47 %) improved with residual neurological dysfunction. Eighteen patients presented with fever, with 56 % having ≥40 °C. Twelve patients (63 %) presented with dysfunction consciousness. Eight (42 %) patients experienced frequent convulsions. All eight patients in our hospital had elevated procalcitonin levels (mean: 21.32 ng/mL, range: 0.10-89.40 ng/mL). Alanine aminotransferase levels were elevated (mean: 632.81 U/L, range: 13.00-2251.00 U/L) in six patients. Seven patients showed elevated uric acid levels(mean: 396.50 μmol/L, range: 157.00-660.00 μmol/L). Brain imaging indicated that all the patients had symmetrical injuries to the bilateral thalami, accompanied by symmetrical injuries in the cerebrum, cerebellum, basal ganglia, and brain stem. Compared with the classical treatment (n = 9), the combination with tocilizumab (n = 6) showed a statistically difference in mortality (p = 0.028 < 0.05).
CONCLUSIONS: The typical clinical manifestations of ANE in children with SARS-CoV-2 infection are acute onset with high fever, frequent convulsions and rapidly worsening disturbance of consciousness. Tocilizumab treatment could reduces mortality in ANE.