神经系统症状在轻度 COVID 患者中常见的是疲劳
根据伦敦大学学院研究人员领导的一项新审查研究，神经和精神症状，如疲劳和抑郁，在 Covid-19 患者中很常见，在轻症患者中也可能出现。
通过回顾 215 项 Covid-19 研究的证据，发表在《神经病学、神经外科和精神病学杂志》上的荟萃分析 报告了 Covid-19 影响心理健康和大脑的多种方式。
主要作者乔纳森·罗杰斯博士（伦敦大学学院精神病学和南伦敦以及莫兹利 NHS 基金会信托基金）说：“我们原以为神经和精神症状在严重的 Covid-19 病例中会更常见，但我们发现有些症状似乎更常见。常见于轻症。看来，影响心理健康和大脑的 Covid-19 是常态，而不是例外。”
研究小组系统地审查了来自 30 个国家的 215 项 Covid-19 研究的证据，共涉及 105,638 名出现 Covid-19 急性症状的人，包括截至 2020 年 7 月的数据（急性指主要疾病阶段，而不是更长的时间）期限影响）。这些研究在追踪哪些症状方面各不相同，研究小组汇总了数据以比较每种症状在追踪它的研究中的常见程度。
在整个数据集中，最常见的神经和精神症状是：嗅觉丧失（嗅觉丧失；43% 的 Covid-19 患者报告）、虚弱（40%）、疲劳（38%）、味觉障碍（味觉丧失；37%）、肌痛（肌肉疼痛；25%）、抑郁（23%）、头痛（21%）和焦虑（16%）。
他们还确定了主要神经系统疾病的存在，例如缺血性中风（数据集中病例的 1.9%）、出血性中风（0.4%）和癫痫发作（0.06%）。整个数据集中的严重 Covid-19 患者比例过高，因为大多数研究都集中在住院患者身上，甚至对院外人员的研究也包括很少有症状非常轻微或没有症状的人。
但在未住院的有症状的急性 Covid-19 患者中，神经和精神症状仍然很常见：55% 的人报告疲劳，52% 的嗅觉丧失，47% 的肌肉疼痛，45% 的味觉丧失，44% 的人报告头痛。研究人员表示，这种症状在严重病例中仍然很常见，因为重症监护患者可能不会报告轻微的症状。
虽然这篇综述没有调查因果机制，但研究人员提出了一些可能的解释。在疾病的急性期，在大脑中发现了炎症，这可以解释一些症状。与全球大流行背景相关的社会心理因素可能会起作用，因为重病患者在看不到家人或朋友时可能会感到孤立，这可能解释了为什么在某些 Covid-19 研究中发现抑郁和焦虑的原因是比流感等其他病毒性疾病更常见。
罗杰斯博士说：“在 Covid-19 感染的早期阶段，许多因素都可能导致神经和精神症状，包括炎症、大脑供氧受损和心理因素。需要更多的研究来更好地理解这些联系。”
联合资深作者 Alasdair Rooney 博士（爱丁堡大学）说：“神经和精神症状在 Covid-19 患者中非常常见。由于全球有数百万人被感染，即使是较罕见的症状也可能比平时影响更多的人。应该为心理健康服务和神经康复服务提供资源，以增加转诊。”
研究人员发现，大多数研究着眼于神经系统症状的一小部分，例如疲劳或肌肉酸痛，而往往忽略了精神疾病的症状，例如抑郁、焦虑和创伤后应激障碍 (PTSD) 以及中风和癫痫发作，因此他们说需要对与 Covid-19 相关的所有症状进行更多研究。
Original Research:
“Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives” by Jonathan Rogers et al. Journal of Neurology, Neurosurgery and Psychiatry
Neurology and neuropsychiatry of COVID-19: a systematic review and meta-analysis of the early literature reveals frequent CNS manifestations and key emerging narratives
Abstract
There is accumulating evidence of the neurological and neuropsychiatric features of infection with SARS-CoV-2. In this systematic review and meta-analysis, we aimed to describe the characteristics of the early literature and estimate point prevalences for neurological and neuropsychiatric manifestations.
We searched MEDLINE, Embase, PsycINFO and CINAHL up to 18 July 2020 for randomised controlled trials, cohort studies, case-control studies, cross-sectional studies and case series. Studies reporting prevalences of neurological or neuropsychiatric symptoms were synthesised into meta-analyses to estimate pooled prevalence.
13 292 records were screened by at least two authors to identify 215 included studies, of which there were 37 cohort studies, 15 case-control studies, 80 cross-sectional studies and 83 case series from 30 countries. 147 studies were included in the meta-analysis. The symptoms with the highest prevalence were anosmia (43.1% (95% CI 35.2% to 51.3%), n=15 975, 63 studies), weakness (40.0% (95% CI 27.9% to 53.5%), n=221, 3 studies), fatigue (37.8% (95% CI 31.6% to 44.4%), n=21 101, 67 studies), dysgeusia (37.2% (95% CI 29.8% to 45.3%), n=13 686, 52 studies), myalgia (25.1% (95% CI 19.8% to 31.3%), n=66 268, 76 studies), depression (23.0% (95% CI 11.8% to 40.2%), n=43 128, 10 studies), headache (20.7% (95% CI 16.1% to 26.1%), n=64 613, 84 studies), anxiety (15.9% (5.6% to 37.7%), n=42 566, 9 studies) and altered mental status (8.2% (95% CI 4.4% to 14.8%), n=49 326, 19 studies). Heterogeneity for most clinical manifestations was high.
Neurological and neuropsychiatric symptoms of COVID-19 in the pandemic’s early phase are varied and common. The neurological and psychiatric academic communities should develop systems to facilitate high-quality methodologies, including more rapid examination of the longitudinal course of neuropsychiatric complications of newly emerging diseases and their relationship to neuroimaging and inflammatory biomarkers.
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