严重急性呼吸综合征患者康复期肺功能评价

目的研究严重急性呼吸综合征(SARS)患者康复期的肺功能动态变化状态。方法对68例康复期SARS患者在出院1、2、3及6个月进行随访,了解其症状、体征和基础疾病,测定肺功能、T淋巴细胞亚群、SARS病毒抗体IgG、血气分析,作胸部高分辨CT。对肺功能各项指标与其他指标作相关性分析。结果所有患者的SARS病毒抗体IgG为阳性。出院1个月时44例有肺功能异常(674%),43例为轻、中度异常(632%),41例有弥散障碍(603%),其中单纯弥散障碍31例(456%),6个月后仍有16例(235%)存在弥散障碍。出院3个月的TLCO较出院1个月明显好转(P<005),出院3个月与6个月的TLCO差异无显著性(P>005)。出院1个月的患者中有35例(515%)胸部CT表现异常,出院3个月的CT变化较出院1个月明显好转(P<005),出院3个月与6个月时的CT变化无显著性差异(P>005)。多元逐步回归分析显示,TLCO与CT异常改变有明显相关性。结论SARS患者康复早期存在不同程度的肺功能损害,但多数为轻、中度异常,肺功能损害以弥散下降为主。出院3个月肺功能明显好转,出院6个月与出院3个月比较肺功能改善无明显差异。

Assessment of pulmonary function in severe acute respiratory syndrome patients during the convalescent period

Objective To investigate the pulmonary function in severe acute respiratory syndrome (SARS) patients during the convalescent period.Methods 68 patients of SARS were followed up for 6 months.The follow-up projects consisted of interview,physical examination,pulmonary function test,thoracic CT scanning,T lymphocyte subsets counts,SARS CoV antibody assay and blood gas analysis.The pulmonary function was tested 1,2,3 and 6 months after discharge.Results Mild to moderate abnormalities in pulmonary function were found in 44 patients (67.4%).31 patients (45.6%) had reduction of diffusion capacity for carbon monoxide (T_~LCO )in the first follow-up and 16 patients (23.5%) had that in the last follow-up.T_~LCO at the first follow-up was significantly different from that at 3 months after discharge,but no signicant difference was found between 3 months and 6 months after discharge.Multiple regression indicated that thoracic CT manifestations was significantly correlated to T_~LCO .Conclusions T_~LCO impairment is the primary pulmonary disturbance in convalescent SARS patients.Pulmonary function might improve gradually by 3 months after discharge.However,little improvement of lung function is found from 3 months to 6 months after discharge.