SARS MERS及COVID-19的临床特点和器官损伤研究进展

三种β-属冠状病毒感染所致的严重急性呼吸综合征(SARS)、中东呼吸综合征(MERS)以及2019新型冠状病毒肺炎(COVID-19)在临床发病特点和器官损伤方面既有相似性也存在一定的差异。对各自特点进行总结比较,有助于探索COVID-19的临床诊治及疫情防控思路。及时评估急性肺损伤的进展状况,预防发生急性呼吸窘迫综合征(ARDS)以及多器官功能障碍对于COVID-19的防治具有重要的临床意义。     

SARS治疗中应用糖皮质激素致糖尿危险应予以重视

因早期、大剂量、长疗程应用糖皮质激素治疗严重急性呼吸综合征 (SARS)从而诱发糖尿病已成为十分突出的临床问题 ,提示该疗法应严格掌握适应症和禁忌症。此类糖尿病的治疗原则与 2型糖尿病大致相同 ,但降糖治疗方案宜充分考虑其下午严重高血糖常伴空腹低血糖的特点。     

不同剂量糖皮质激素在治疗SARS的临床观察——附20例病例分析

目的:回顾性对比分析二种不同初始剂量的糖皮质激素治疗严重急性呼吸综合症(SARS)的效果,评价糖皮质激素的用量和应用时机问题。方法:SARS患者20例,符合我国卫生部发布的《传染性非典型性肺炎临床诊断标准(试行)》。患者入院后常规使用肾上腺糖皮质激素、利巴韦林及解热镇痛药,同时给予支持疗法。按照肾上腺糖皮质激素初始量不同分为冲击治疗组和亚冲击治疗组。冲击组初始剂量采用甲基强的松龙320~480mg,亚冲击组初始剂量采用80~160mg。2组用药前后详细记录体温、胸片变化及一般情况。结果:2组患者治疗4周后比较:冲击组有效率100%,亚冲击组有效率80%,2组相比差异无显著性,显效率冲击组为70%,亚冲击组为10%,有明显差异。冲击组的病程为(27·0±6·9)d,亚冲击组为(33·6±7·6)d,2组比较有差异,冲击组的激素总量为(4394·0±2402·3)mg,亚冲击组的激素总量为(5742·0±2775·9)mg,2组比较无差异。冲击组中30%追加激素,亚冲击组80%追加激素,2组比较有差异;冲击组20%出现2次发热,亚冲击组2次发热占到70%,2组差异有显著性;冲击组20%使用呼吸机,亚冲击组40%使用呼吸机,2组差异无显著性。冲击组2次发热出现较少,肺部阴影吸收较快,病程明显缩短,而亚冲击组糖皮质激素的初始剂量相对较小,糖皮质激素的用量随体温和胸片的进展递增,应用的时间较长,激素总量增多,副作用增加,并发症较多,病程相对延长。结论:我们对二种不同初始剂量分别做对比分析,认为冲击组优于亚冲击组。使用肾上腺糖皮质激素的亚冲击组2次发热率较高,追加激素率增加,激素总用量增加,病程相对延长,激素的副作用也相对增加。     

SARS病毒感染与糖皮质激素的应用

自从 2 0 0 3年 3月 15日世界卫生组织 (WHO)向全球正式提出严重急性呼吸综合征 (SARS)的概念 ,呼吁医务人员和旅行者注意SARS的症状。 4月 16日WHO宣布新型冠状病毒是SARS的病原体。 5月 1日首批评议的 SARS病毒基因组序列研究结果刊出 ,六天以后 WHO专家确认过度免疫反应是导致 SARS患者死亡的决定因素。 2 0 0 3年5月 8日全球已报告超过 70 0 0名 SARS病例 ,其中5 0 0例死亡。香港 Lee等在“《中国医学论坛报》(2 0 0 3年 4月17日 )中报道了 138例 SARS患者均有发热 ,其热度可达 4 0 .3℃ ,中位数为 38.4℃。咳嗽、头痛…     

中山市首批重症SARS应用糖皮质激素的回顾性分析

目的探讨糖皮质激素在严重急性呼吸综合症(SARS)治疗价值及时机。方法回顾性分析中山市人民医院和中医院于2003年1-3月收治的11例重症SARS临床资料,总结治疗效果,探讨糖皮质激素治疗的最佳时机及剂量。结果9例重症SARS用糖皮质激素治疗后肺炎吸收,有效率81.8%,开始用激素治疗的时间在起病后平均6.8天。结论糖皮质激素是治疗SARS的有效手段之一,只要应用剂量和时机得当,对于有糖尿病、高血压、溃疡病等基础病的病人也是安全的。     

严重急性呼吸综合征糖皮质激素的应用

严重急性呼吸综合征 (SARS)起病急 ,进展快 ,主要的死亡原因是短时间内出现急性呼吸窘迫综合征 (ARDS)。死亡患者的尸检结果显示 :典型的病理变化有肺间质水肿、间质纤维化、局灶性出血、肺血管充血、肺泡细胞增生、透明膜形成等。由于糖皮质激素能减轻肺的渗出、损伤和后期的肺纤维化。故参照广州的经验 ,在治疗SARS中应用激素。我院自 2 0 0 3年 3月 1 1日至 5月 1 0日收治了1 71例患者 ,出院 81例 ,对于如何使用激素有一些粗浅的体会 ,我们认为不必所有患者均应用糖皮质激素 ,但大部分患者宜尽早应用 ,现介绍如下。1 .应用指征有下…     

国内外SARS 临床研究进展

综述近期严重急性呼吸综合征(SARS)的国内外研究进展,就SARS的流行病学、临床表现、诊断、实验室检查、影像学检查、治疗、预防与转归等方面进行阐述,初步总结了SARS的潜伏期、性别、年龄、职业分布、传染情况、病死率、并发症、传染性、临床症状、肝功能、肾功能、心肌酶谱变化、血液学改变、尸检病理改变、胸片、胸部CT改变、激素、抗生素、抗病毒剂、及综合治疗、复发及其预后判断概况.     

老年SARS的临床表现和诊治特点

严重急性呼吸综合征(severe acute respiratory syndrome,SARS)是由SARS冠状病毒引起的一种急性呼吸道传染病.患者中青壮年占绝大多数,老年患者虽然数量较少,但由于其生理功能的特点,其疾病的流行病学特点、临床表现、预后和治疗都具有一定的特殊性.     

糖皮质激素在重症急性呼吸综合征治疗中的应用

传染性非典型肺炎 ,世界卫生组织命名为重症急性呼吸综合征 (SARS) ,是一种由变异冠状病毒感染引起的新的呼吸道传染性疾病。自从 2 0 0 2年底以来 ,首先在广东报道 ,全球先后有 31个国家和地区受累 ,报告病例 84 37例 ,死亡 813例 (截至 2 0 0 3年 7月 11日 )。起病急 ,以发热为首发症状 ,体温一般 >38℃ ,可有咳嗽、咳白痰或血丝痰 ,严重者出现呼吸加速、气促或明显呼吸窘迫 ,X线胸片病灶常进行性发展 ,于病程第 2周达高峰 ,部分病例发展为I型呼吸衰竭 ,达到急性肺损伤或急性呼吸窘迫综合征的诊断标准。SARS常继发感染而引起严重并发…     

非糖皮质激素治疗严重急性呼吸综合征29例临床分析

目的　探讨未使用肾上腺糖皮质激素治疗的严重急性呼吸综合征 (SARS)患者的临床经过。方法　作者对 2 9例非糖皮质激素治疗的SARS患者的临床资料和治疗经过作回顾性分析。结果　 ( 1) 2 9例中 ,男 6例 ,女 2 3例 ,平均年龄 ( 2 7 8± 8 6 )岁。潜伏期 ( 6 0± 3 4 )d ,平均住院时间 ( 12 1± 3 3)d ,全部患者康复出院。 ( 2 )所有患者均有发热 ,初始体温 ( 38 3± 0 6 )℃ ,最高体温 ( 39 0± 0 7)℃ ,持续发热时间 ( 7 3± 3 2 )d。 ( 3)入院时受累肺野数目 ( 1 0± 0 6 )个 ,病程中最大受累肺野数目 ( 1 8± 1 0 )个 (P <0 0 0 1) ,37 9%患者双侧肺部受累。72 4 %患者外周血白细胞计数减少。 ( 4 ) 10 0 %患者使用抗生素 ,主要是四环素类、氨基糖苷类和氟喹诺酮类。31 0 %使用干扰素α ,4 4 8%使用丙种球蛋白 ,10 0 %使用口服抗病毒药物。结论　中毒症状不重、病变范围相对局限、且无氧合障碍的SARS患者可以不用糖皮质激素治疗。     

MERS,SARS and other coronaviruses as causes of pneumonia

Human coronaviruses (HCoVs) have been considered to be relatively harmless respiratory pathogens in the past. However, after the outbreak of the severe acute respiratory syndrome (SARS) and emergence of the Middle East respiratory syndrome (MERS), HCoVs have received worldwide attention as important pathogens in respiratory tract infection. This review focuses on the epidemiology, pathogenesis and clinical characteristics among SARS‐coronaviruses (CoV), MERS‐CoV and other HCoV infections.     

Pneumothorax in a COVID-19 Pneumonia Patient without Underlying Risk Factors

Coronavirus disease 2019 (COVID-19) has been recognized as a worldwide pandemic. However, the clinical course of COVID-19 remains poorly characterized. Although some cases of pneumothorax have been reported, they all had pulmonary complications or were managed with mechanical ventilation. We herein report a case of pneumothorax that developed even though the patient had no pulmonary underlying diseases and had never been managed with mechanical ventilation. In the present case, a lung bulla was found on chest computed tomography during treatment for COVID-19. We concluded that COVID-19 affected the formation of the lung bulla and induced the complication of pneumothorax.     

Immune Profiling of COVID-19 in Correlation with SARS and MERS

Acute respiratory distress syndrome (ARDS) is a major complication of the respiratory illness coronavirus disease 2019, with a death rate reaching up to 40%. The main underlying cause of ARDS is a cytokine storm that results in a dysregulated immune response. This review discusses the role of cytokines and chemokines in SARS-CoV-2 and its predecessors SARS-CoV and MERS-CoV, with particular emphasis on the elevated levels of inflammatory mediators that are shown to be correlated with disease severity. For this purpose, we reviewed and analyzed clinical studies, research articles, and reviews published on PubMed, EMBASE, and Web of Science. This review illustrates the role of the innate and adaptive immune responses in SARS, MERS, and COVID-19 and identifies the general cytokine and chemokine profile in each of the three infections, focusing on the most prominent inflammatory mediators primarily responsible for the COVID-19 pathogenesis. The current treatment protocols or medications in clinical trials were reviewed while focusing on those targeting cytokines and chemokines. Altogether, the identified cytokines and chemokines profiles in SARS-CoV, MERS-CoV, and SARS-CoV-2 provide important information to better understand SARS-CoV-2 pathogenesis and highlight the importance of using prominent inflammatory mediators as markers for disease diagnosis and management. Our findings recommend that the use of immunosuppression cocktails provided to patients should be closely monitored and continuously assessed to maintain the desirable effects of cytokines and chemokines needed to fight the SARS, MERS, and COVID-19. The current gap in evidence is the lack of large clinical trials to determine the optimal and effective dosage and timing for a therapeutic regimen.     

新型冠状病毒肺炎诊断研究进展

新型冠状病毒肺炎(COVID-19)疫情以来,疾病的高传染性使确诊人数剧增,同时死亡人数也在日益增加。现全球已有200余个国家或地区出现感染病例。疾病的早诊可以有效控制疾病传播,同时使感染者得到有效的隔离和救治,提高生存率。目前,中国COVID-19的控制取得了阶段性胜利。本文对COVID-19的临床表现、实验室检查、...     

Tracheostomy for COVID-19 respiratory failure: timing,ventilatory characteristics,and outcomes

BackgroundWhereas data from the pre-pandemic era have demonstrated that tracheostomy can accelerate liberation from the ventilator, reduce need for sedation, and facilitate rehabilitation, concerns for healthcare worker safety have led to disagreement on tracheostomy placement in COVID-19 patients. Data on COVID-19 patients undergoing tracheostomy may inform best practices. Thus, we report a retrospective institutional cohort experience with tracheostomy in ventilated patients with COVID-19, examining associations between time to tracheostomy and duration of mechanical ventilation in relation to patient characteristics, clinical course, and survival.MethodsClinical data were extracted for all COVID-19 tracheostomies performed at a quaternary referral center from April-July 2020. Outcomes studied included mortality, adverse events, duration of mechanical ventilation, and time to decannulation.ResultsAmong 64 COVID-19 tracheostomies (13% of COVID-19 hospitalizations), patients were 64% male and 42% African American, with a median age of 54 (range, 20–89). Median time to tracheostomy was 22 (range, 7–60) days and median duration of mechanical ventilation was 39.4 (range, 20–113) days. Earlier tracheostomy was associated with shortened mechanical ventilation (R²=0.4, P<0.01). Median decannulation time was 35.3 (range, 7–79) days. There was 19% mortality and adverse events in 45%, mostly from bleeding in therapeutically anticoagulated patients.ConclusionsTracheostomy was associated with swifter liberation from the ventilator and acceptable safety for physicians in this series of critically ill COVID-19 patients. Patient mortality was not increased relative to historical data on acute respiratory distress syndrome (ARDS). Future studies are required to establish conclusions of causality regarding tracheostomy timing with mechanical ventilation, complications, or mortality in COVID-19 patients.     

Successful Use of Certolizumab Pegol for Refractory Psoriatic Arthritis Triggered by COVID-19 Infection

Recently, the coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2, has spread worldwide. Although nearly all patients incur mild-to-moderate disease from this viral infection, some develop severe manifestations with a poor prognosis. COVID-19 can also induce autoimmune disease; several cases of arthritis following COVID-19 have been documented in the literature, such as reactive arthritis and chronic arthritis. We herein report a case of psoriatic arthritis triggered by COVID-19. Although the arthritis had been refractory to glucocorticoids and methotrexate, certolizumab pegol subsequently led to remission.     

COVID-19 compared to other epidemic coronavirus diseases and the flu

Coronaviruses are among the largest group of known positive - sense RNA viruses with a wide range of animal hosts as reservoir. In the last two decades, newly evolved coronaviruses such as the severe acute respiratory syndrome coronavirus (SARS-CoV) which caused the infamous 2002 outbreak, the Middle East respiratory syndrome coronavirus (MERS-CoV) which caused an outbreak in 2012, and now the SARS-CoV-2 [responsible for the current coronavirus disease 2019 (COVID-19)] have all posed notable threats to global public health. But, how does the current COVID-19 outbreak compare with previous coronaviruses diseases? In this review, we look at the key differences between SARS-CoV, MERS-CoV, and SARS-CoV-2, and examine challenges in determining accurate estimates of the severity of COVID-19. We discuss coronavirus outbreaks in light of key outbreak severity indicators including, disease fatality, pathogen novelty, ease of transmission, geographical range, and outbreak preparedness. Finally, we review clinical trials of emerging treatment modalities and provide recommendations on the control of COVID-19 based on the mode of transmission of the coronaviruses. We also recommend the development and use of a standardized predictive epidemic severity models to inform future epidemic response.