重症急性呼吸综合征影像学变化和临床分期的研究

目的分析重症急性呼吸综合征(SARS)患者临床特点、实验室检测结果和胸部影像学变化,提出临床分期.方法对2003年3～5月间有完整胸部影像学动态变化和实验室检测数据的45例SARS患者进行分析.结果 (1)影像学变化普通型23例肺部出现一侧片状阴影为病程的2～5(2.9±1.0) d;发展到双侧2～11(6.9±2.5) d;出现双肺广泛磨玻璃样变、实变6～19(11.0±2.0) d;开始吸收为10～21(15.0±4.1) d;胸部影像学改变完全吸收为18～46(25.9±7.2) d.重型患者22例发展到双肺广泛磨玻璃样变、实变(9.0±3.2) d,与普通型相比,差异无显著性(P>0.05);开始吸收为(19.0±4.6) d, P=0.009, 胸部影像学改变完全吸收为(36.0±8.1) d, P=0.001, 其中7例死亡患者胸部影像学表现均在7 d内进展到双肺广泛实变.(2)实验室检测早期SARS患者T细胞亚群和淋巴细胞明显降低,38例存活组患者在10～15 d恢复;但7例死亡患者T细胞亚群和淋巴细胞未见恢复.结论 SARS患者可分5期潜伏期2～10 d,前驱期1～3 d,进展期4～7 d,极期8～15 d,恢复期16～24 d.从发病到胸部影像学改变初步吸收时间为10～15 d.1周之内进展到双肺广泛实变且2周左右T细胞亚群和淋巴细胞不能恢复的患者,可能预后极差.

Chest X-ray features of severe acute respiratory syndrome and clinical staging

OBJECTIVE: To establish a clinical staging system for patients with severe acute respiratory syndrome (SARS) based on clinical feature, laboratory tests as well as dynamic changes of chest X-ray images. METHOD: Dynamic changes of chest X-ray images and laboratory tests in 45 SARS patients managed from March to May, 2003 were analyzed. RESULTS: (1) Chest X-ray image: among 45 cases, 23 were common type: the time to appearance of unilateral patched shadow of the lung were 2 to 5 (2.9 +/- 1.0) days. The time to appearance of bilateral patched shadow of the lungs were 2 to 12 (6.9 +/- 2.5) days. The time to appearance of ground glass or consolidation in the lung were 6 to 19 (11.0 +/- 2.0) days. The time to the beginning of absorption of X-ray changes were 10 to 21 (15.0 +/- 4.1) days. The time for chest X-ray image to be absorbed completely were 18 to 46 (25.9 +/- 7.2) days. Twenty-two patients were severe type, in which the time to the appearance of ground glass of the lung were (9.0 +/- 3.2) days, with no significant difference when compared with common type (P < 0.05). However, the time to the beginning of absorption and complete absorption were (19.0 +/- 4.6) days (P = 0.009) and (36.0 +/- 8.1) days (P = 0.001), respectively. Noticeably, the time to pan-consolidation of the lung were less than 7 days in 7 fatal cases. (2) Laboratory tests: decrease in the number of lymphocytes and T lymphocyte subset were seen in the early stage. While the account recovered in 10 to 14 days of disease course in the 38 patients who survived, there was no recovery in 7 patients who died. CONCLUSIONS: SARS can be divided into five stages: incubation period 2 to 10 days, prodromal period 1 to 3 days, progressive period 4 to 7 days, advanced period 8 to 15 days were, convalescent period 16 to 24 days. The appearance of pan-consolidation in the lung in less than 7 days and/or unable to recover the number of lymphocytes and T lymphocyte subset will be associated with poor prognosis.