研究发现小儿中风与 COVID-19 感染有关，但与多系统炎症综合征无关

 

概要

 

最近发表在《儿科神经病学》上的一项研究中，研究人员调查了2019年冠状病毒病（COVID-19）和儿童多系统炎症综合征（MIS-C）是否与儿科人群中缺血性中风的风险增加有关。

研究人员对两组18岁以下儿童进行了回顾性分析：第一组包括2020年3月至2021年6月期间被诊断为颅内出血、脑梗塞、缺血性中风或脑血管意外的儿童；第二组包括2015年3月至2020年2月期间因中风住院的儿童。研究还对受试者人口统计学特征的数据进行了统计，此外还评估了如病史、核酸检测结果、COVID-19疫苗接种数据、重症监护室的入院日期和时间、COVID-19症状发作和中风时间、特征、治疗方案以及治疗结果等相关信息。

研究结果显示，16例年龄在8个月至17岁之间的小儿缺血性脑卒中，缺血性中风的发生率与儿童COVID-19感染的增加有关，但与MIS-C的发生率增加无关。三分之一的中风患者以前有SARS-CoV-2感染史，被诊断为MIS-C，没有接种疫苗，或者在中风时有SARS-CoV-2抗体。由于这段时间的其他病毒感染已经减少，所以COVID-19被认为是中风的一个诱因。

此外，没有发现急性SARS-CoV-2感染与中风有关，这表明中风可能与COVID-19患者在康复后2至6周内观察到的高炎症状态存在联系。同样，由于病毒感染引起的凝血级联的激活和内皮损伤导致的促血栓状态和高凝状态也与儿科患者中风的发生有关。

研究结果表明，中风是COVID-19感染的延迟并发症，但与MIS-C无关。此外，由于症状模糊，儿童患者的中风往往被诊断得很晚，这耽误了患者的疾病干预和治疗。

 

 

Study finds that pediatric stroke is associated with COVID-19 infections but not with multisystem inflammatory syndrome

 

In a recent study published in  Pediatric Neurology, researchers investigated whether coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) were associated with an increased risk of ischemic stroke in pediatric populations.

 

Study: SARS-CoV-2 Infection and Increased Risk for Pediatric Stroke. Image Credit: joel bubble ben/Shutterstock

 

Background

 

Growing evidence suggests that adult COVID-19 patients are at an increased risk of stroke, which is attributed to various factors such as hypercoagulability, immune-mediated thrombosis, changes in the renin-angiotensin system, cardioembolism, and other COVID-19 mediated changes to the cardiac and nervous systems.

 

The ability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to use the angiotensin-converting enzyme-2 (ACE-2) receptors to enter host cells is also linked to neurotropism and the effect of the virus on multiple organ systems.

 

However, there is a scarcity of information on whether children with COVID-19 are at a higher risk of stroke. While studies have found no increase in the risk of ischemic stroke in pediatric COVID-19 patients during the early pandemic, neurological complications, and some forms of vasculopathy have been observed in a quarter of the MIS-C patients. Furthermore, while thromboembolism and stroke have been considered rare complications of MIS-C, the causal relationships are not well understood.

 

About the study

 

In the present study, the researchers conducted retrospective analyses on two population-based cohorts of children under 18. The first cohort included children diagnosed with intracranial hemorrhage, cerebral infarction, ischemic stroke, or cerebrovascular accident between March 2020 and June 2021. The second comprised children hospitalized with stroke between March 2015 and February 2020 at the Primary Children's Hospital in Utah, United States.

 

Data on demographic characteristics such as gender, age, socioeconomic status, insurance coverage, and race or ethnicity were obtained from electronic records. Additional information such as medical histories, COVID-19 polymerase chain reaction (PCR) test results, COVID-19 vaccination data, hospital, and intensive care unit admission dates and duration, the time elapsed between COVID-19 symptom onset and stroke, National Institute of Health Stroke Scale (NIHSS) upon presentation of stroke, stroke characteristics, treatment administered, and stroke outcomes were evaluated.

 

Results

 

The results reported 16 cases of pediatric ischemic strokes in patients between the ages of eight months and 17 years. The incidence of ischemic stroke was correlated with an increase in COVID-19 infections in children but was not associated with an increased occurrence of MIS-C.

 

One-third of the patients who had a stroke had previous SARS-CoV-2 infections, had been diagnosed with MIS-C, were not vaccinated, or had antibodies against SARS-CoV-2 when they suffered the stroke. Since other viral infections during the time had decreased, COVID-19 is thought to be a trigger for stroke. Contrary to previous studies that reported increased focal cerebral arteriopathy associated with COVID-19, the present study found large-vessel occlusive stroke more prevalent in the pandemic and pre-pandemic cohorts.

 

While three of the patients had been diagnosed with MIS-C at the stroke time, three other patients with mild or asymptomatic previous SARS-CoV-2 infections and no diagnosed MIS-C patients also suffered strokes. Only a quarter of the pandemic cohort patients were administered tissue plasminogen activator or a thrombectomy since the diagnosis of stroke in most patients in the pandemic, and pre-pandemic cohorts were delayed.

 

Furthermore, acute SARS-CoV-2 infections were not found to be associated with stroke, suggesting that stroke could be associated with the hyperinflammatory state observed in COVID-19 patients in the two to six weeks after recovery. Additionally, the prothrombotic state and hypercoagulability that results from the activation of clotting cascades and endothelial damage due to the viral infection have also been implicated in the occurrence of strokes in pediatric patients.

 

The study suggested that stroke could occur a month after the COVID-19 infection, possibly due to the hypercoagulability and prothrombotic state resulting from the weeks following SARS-CoV-2 infections. Furthermore, since the incidence of stroke in the pediatric population is rare, and the presentations of stroke symptoms in children are vague, it is often misdiagnosed or diagnosed late, delaying intervention.

 

Conclusions

 

To summarize, the study investigated the association between stroke, COVID-19 infections, and multisystem inflammatory syndrome in children using a retrospective analysis on two cohorts of pediatric stroke patients, one spanning the COVID-19 pandemic and one pre-pandemic.

 

The results indicated that stroke is a delayed complication of previous SARS-CoV-2 infections but is not associated with acute infections or MIS-C. Furthermore, stroke is often diagnosed late in pediatric patients due to vague symptoms, delaying treatments and interventions.

 

Source:

News-Medical

Published on Novembre 24 2022

 

 

声明：本站文章版权归原作者及原出处所有。本文章系本站编辑转载，文章内容为原作者个人观点，登载该文章的目的是为了学习交流和研究，并不代表本站赞同其观点和对其真实性负责，本站只提供参考并不构成任何投资及应用建议。

本站是一个学习交流和研究的平台，网站上部分文章为引用或转载，并不用于任何商业目的。我们已经尽可能的对作者和来源进行了告知，但是能力有限或疏忽，造成漏登或其他问题，请及时联系我们，我们将根据著作权人的要求，立即更正或删除有关内容。本站拥有对本声明的最终解释权。