感染COVID的中风患者比未感染的患者表现更差

Host Amber Smith: Upstate Medical University in Syracuse New York invites you to be "The Informed Patient," with the podcast that features experts from Central New York's only academic medical center. I'm your host, Amber Smith. People who had strokes during the pandemic and who were also found to be infected with COVID had worse outcomes than those who were COVID-free, according to research in the journal, neurology. 我将会和Dr. Navreet Kaur, who is completing her fourth year of residency in neurology at Upstate. Welcome to "The Informed Patient," Dr. Kaur.

Navreet Kaur, MD: Good morning.

Host Amber Smith: The paper published in the journal Neurology references the global COVID-19 Stroke Registry. What is that?

Navreet Kaur, MD: The global registry is basically a database, which is IRB (Institutional Review Board) approved research where data is collected and coordinated at a specific site. 这个网站隶属于瑞士的一个中心, and they did a couple of studies during the COVID time to obtain this data and research how the things were in the stroke world before pandemic and during pandemic.

那么全世界有多少机构加入了这个注册表呢? 我猜北州就是其中之一，对吧?

Yes, Upstate is one of them. 我们今天讨论的这个研究涉及105个中心, from roughly 20-plus countries in the world. And then we got the approval from IRB before collecting the data and sending it to the coordinating site.

Host Amber Smith: Now this is a retrospective study, 这意味着研究人员在接受治疗后回顾了一组患者. What time period did this cover?

Navreet Kaur, MD: This covered the time period from March 2020, which was beginning of the pandemic, till June 2021. So these were the initial time period where everything was new with regards to COVID and stroke care. So these time periods were covered among all the 105 centers from where data was collected.

Host Amber Smith: And which types of patients were included?

Navreet Kaur, MD: 所有入院时有急性中风问题的患者, 我们通常认为是单侧虚弱, numbness, speech trouble, vision trouble. 所有在发病24小时内出现这些症状的病人, 然后他们在那段时间到达了医院, were screened and were given care based on the criteria they meet with two different therapies.

Host Amber Smith: What are the two different therapies?

Navreet Kaur, MD: One therapy is an intravenous injection. We call it clot-busting medication. 这是在症状出现后四个半小时内给予的. And another therapy is endovascular therapy, where doctors go all the way into the brain to take out the clot that is blocking large vessels in the brain, causing the stroke symptoms.

Host Amber Smith: Now before we get into the results or the findings, can you give us some background? 医生认为COVID-19和中风之间有联系吗?

Navreet Kaur, MD: Yes. I think COVID-19, 一般的判断是，它首先影响肺部, that you'll get runny nose, fever, sore throat. But in fact, it does infect the multisystem organs, so it'll have effect on all the organs, primarily brain. It leads to damage to the vessels in the brain, 会引起炎症导致更多血栓的形成吗. And that leads to stroke. So there is a direct connection.

Host Amber Smith: So this inflammation affects the whole body, not just the lungs, certainly, and not just the neurological?

Navreet Kaur, MD: Yes. 所以COVID可以通过不同的方式影响我们, 一是它会损害大脑中的血管. 我们称之为“内皮功能障碍”.“所以我们的大脑有小血管，里面有细胞, and when we have any infections, be it COVID or anything else, it affects those vessels.

We discovered that COVID affected us more. It directly damages those blood vessels, and people far more clots that lead to stroke. 另一件事是它会导致凝血功能障碍. That prompts us to make more strokes.

Host Amber Smith: And are those conditions that stay with a person forever after they've had COVID?

Navreet Kaur, MD: It is really hard to comment on that, 但我们确实知道，短期影响是存在的, that predisposes patients to have more strokes. So when we say coagulopathy, just to describe it in a simple way, 人们会有血栓形成或破裂的问题. So both the things are affected. They will form more clots, and then those clots will break up more and they will go to the other parts of the body affecting us. In stroke, 我们说血凝块可以分解成小块, go with the blood flow to the brain, causing more strokes.

So that's kind of a cycle of more stroke clots, and then them breaking, giving more strokes.

Host Amber Smith: 这里是纽约州推荐最近最火的赌博软件的“知情患者”播客. 我是主持人，安珀·史密斯，我正在和史密斯博士谈话. Navreet Kaur about an interesting global study she was involved in that looked at patients who had strokes during the pandemic and compared the outcomes between those who tested positive for COVID and those who were found to be COVID-free.

Now the global COVID-19 stroke registry included more than 15,000 patients from 105 centers. What percentage were found to have COVID-19?

Navreet Kaur, MD: Roughly 5.6% of the patients, a total of 853 patients in the study, were COVID-positive at the time of stroke.

Host Amber Smith: For the treatment, 他们中有百分之多少的人服用了抗凝血药物, 有多少人接受了你所说的血管内手术?

Navreet Kaur, MD: 大约38%的人接受了我们所说的静脉注射, the clot-busting medication. And about 61% of the people got the endovascular therapy where we go all the way up in the brain to take the clot out.

Host Amber Smith: So looking at those with COVID-19, 他们的结果与没有感染COVID-19的人相比如何?

Navreet Kaur, MD: 当我们比较COVID阳性和非COVID阳性患者时, we saw that the patient who had COVID during the time of the stroke had a worse outcome. So when we say in our stroke world, 最坏的结果意味着他们的考试正在恶化, like they are more weak, they're more numb. 我们通过对大脑进行重复扫描来测量.

So our threshold for doing a repeat scan is if their stroke scale is worse than more than four points of what was when they came in. 假设他们有一个弱点，他们麻木，他们的中风等级是10. 后来他们接受了中风治疗，现在14岁了. 然后做CAT扫描，发现有出血. We say that that's significant. So these patients had more bleeds in the brain. They had poorer outcomes at 24 hours. 我们对他们进行了三个月的跟踪调查, they had worse outcomes as compared to people who were COVID negative at the time of stroke.

Host Amber Smith: 你能解释或推测为什么他们的结果如此糟糕吗?

Navreet Kaur, MD: 我们认为，这和我们之前讨论的是一样的. 更多的血栓形成，更多的炎症，更多的损伤. So we realized that these people who were getting treated for stroke had more stroke within the acute short period when they were in the hospital or followed through.

有一件事是确定的，那就是血块很难取出来. Like we have seen that the patients who required the interventional endovascular therapy, they had more failed outcomes, which we measure with the perfusion. Or the amount of blood they are taking back to the brain after we take the clot out. So they were not able to have that good blood supply and perfusion after the surgery, 这告诉我们这些血块可能和正常情况下不一样.

Host Amber Smith: 这项研究是在疫苗出现之前进行的. Do you think the results would be different today if the patients testing positive for COVID had previously been vaccinated?

Navreet Kaur, MD: I think that would be very difficult to say as well because COVID has many variants, 有些人的炎症反应比其他人更强烈. 所以如果我们这样想，接种疫苗的病人, they're not that severely sick, 也许他们没有那么多的损伤或炎症. 所以他们的症状和中风症状没有那么严重. 但我们没有任何数据或大型研究来证明这一点. So theoretically, maybe yes, they will have lesser stroke, 但我们需要更多的研究来得出结论.

Host Amber Smith: Have the findings from this paper altered the way you treat patients with stroke? Who test positive for COVID-19?

Navreet Kaur, MD: 我们总是对病人做同样的治疗, the intravenous therapy within four and a half hours and the endovascular therapy within 24 hours of the symptom onset.

我们唯一认为的是一个感染了COVID的病人, we have to be very vigilant that these patients have tendency to form more clots and have more strokes. So we do close monitoring for everyone. So we do them the same treatment. 尽管他们在这项研究中确实有更糟糕的结果, 尽管如此，这仍然是一种标准的治疗方法，应该给予所有的病人. So I think we, 我们也在做我们对已知COVID患者所做的事情, 我们将继续这样做，直到我们有更多的数据.

Host Amber Smith: Do you think any of the same concerns that apply to stroke patients who test positive might also apply to a stroke patient who survived COVID but has the lingering long COVID symptoms that we've heard about?

Navreet Kaur, MD: That is a great question. So, COVID we know that within six months to a year -- and there have been studies to say that -- that people have more tendency to form more clots within first six months to a year of a COVID infection. So perhaps yes.

In this particular study, we did not include the patients who were positive more than seven days before they received this treatment. So we just included the acute patients. But if we think about the inflammatory response that COVID brings to patients body, yes, 他们有可能是高凝性的, 这意味着他们在最初的几个月里更容易形成血栓, 尤其是感染后的三到六个月. 但是，我们没有任何研究来证明这一点.

Host Amber Smith: Dr. 考尔，非常感谢你抽出时间来接受采访.

Navreet Kaur, MD: Thank you so much for having me.

Host Amber Smith: My guest has been Dr. 纳夫里特·考尔(Navreet Kaur)，他即将在上州医院完成为期四年的神经病学住院医师实习期. “知情的病人”是一个关于健康的播客, science and medicine, 由锡拉丘兹上州医科大学为您带来, New York, and produced by Jim Howe. 在Upstate找到我们之前的剧集.edu/Informed. 我是主持人安珀·史密斯，感谢大家的收听.