天津市传染性非典型肺炎康复者健康状况的随访研究

目的 了解天津市传染性非典型肺炎（SARS）康复者健康状况及其主要并发症的转归，并通过特异性抗体检测完成血清学诊断，观察抗体时间变化规律。方法对2003年天津市SARS流行期间经住院治疗康复的220人，进行了发病后14个月内分3个阶段的随访研究。对全部随访者进行了血清SARS-CoV特异性抗体IgG、IgM以及淋巴细胞亚群、血生化等指标检测，同时进行了肺部高分辨CT检测和双侧髋关节MRI检测。结果随访患者中，原SARS临床确诊、临床疑似和临床观察病例的SARS-CoV特异性抗体IgG的阳性率分别为99．34％，87．5％和45．59％，提示临床疑似和临床观察病例中有较多病人漏诊。随访早期发现87人存在肺功能或（和）肺间质性变化，经过8个月观察，影像学显示46人肺部病变自愈，其余41人肺部病变也明显好转。49人发生股骨头坏死，仅在SARS-CoV特异性抗体阳性患者中发生，且多为Ⅰ期病变，经多因素分析显示，股骨头坏死与SARS病毒感染以及住院期间激素的平均使用量的联合作用有关。结论血清学诊断在SARS患者感染确证中不可缺少，应在恢复期早期进行血清抗体检测。康复者肺间质性改变有自愈倾向，股骨头坏死的发生是病毒感染与激素联合作用的结果。

The Follow-up Study on the Health Status of Convalescent Patienrs Recovered from SARS in Tianjin

Objective To understand the health status and their main complications in convalescent patients recovered from SARS in Tianjin after the 2003 epidemic,and with the detections of the serum specific IgG to make a serological diagnosis and to observe its change with time.Methods 220 cases from the 296 recovered patients with clinical SARS diagnosed in 2003 were willingly to join this follow-up study for three stages during the 14 months of post-infection.All cases were detected on the contents of SARS-CoV specific IgG & IgM,subgroups of T cells,cytokines and other blood profiles,while on their lungs by high solution CT and their hipbone joints by MRI.Results All cases were diagnosed by serum test on their specific SARS-CoV IgG.The positive rates of the specific SARS-CoV IgG were 99.34%,87.5% and 45.59%,respectively in diagnosed patients,suspicious patients and observed cases with clinical diagnosis criterion during the epidemic.87 cases were suffered from interstitial lung diseases,and the CT imagine showed 46 cases of them were completely recovered at the end of the study,while the other 41 cases also showed obviously improvement in the lungs.There were 49 cased who suffered from the necrosis of the femoral head(ANFH) and no marked changes were found in their MR imaging during the study.With the multivariate analysis,the result showed the occurrence of ANFH was related with the concurrent of SARS-CoV infection and the average usage dose of the Glucocorticoids in clinic.Conclusion It was indispensable to make a serological detection of the specific IgG for the SARS diagnosis and it should been done in the early stage of the convalescent period.The interstitial lung disease showed a trend of auto-recovery and the occurrence of ANFH was related to the combination of SARS-CoV infection and the usage of Glucocorticoids in clinic.