关于严重急性呼吸综合征的反思

20 0 3年 6月 2 4日 ,北京终于以 2 50 0余人患病 ,1 91人死亡的代价迎来了“双解除”。我们在庆幸有效控制严重急性呼吸综合征 (SARS)流行的同时 ,也应及时总结经验与教训 ,为有朝一日SARS卷土重来或其他重大公共卫生事件的发生做好准备。一、防治的成功与科研的缺憾2 0 0 3年 4月 2 0日以来 ,政府采取了果断的措施 ,充分发挥了“群众运动”的优势 ,仅用 2个月的时间就使SARS在全国范围内得到有效控制 ,避免了更大的损失 ,不能不说这是一个巨大的成就 ,是一奇迹 ,也是其他国家无法效仿的。但是 ,有关部门如果从开始阶段就能对SARS的…     

Haematological parameters in severe acute respiratory syndrome

Clinical presentation of severe acute respiratory syndrome (SARS) is non-specific and isolation of all suspected patients is difficult because of the limited availability of isolation facilities. We studied changes in haematological parameters in SARS patients using median values analysed according to the day of symptom onset. White cell (WCC), absolute neutrophil, absolute lymphocyte (ALC) and platelet counts followed a v-shaped trend with the nadir at day 6 or 7 after symptom onset except for ALC in the ICU group that had not reached the nadir by day 12. None of our patients had a platelet count < 80 x 10(9)/l and WCC < 2 x 10(9)/l in the first 5 days of symptoms and these parameters may allow early stratification of febrile patients into likely and unlikely SARS cases to allow effective utilization of isolation facilities. On multivariate analysis, age is the only independent predictor for ICU admission.     

严重急性呼吸道综合征研究动态

世界卫生组织 (WHO)和美国疾病预防与控制中心 (CDC)正致力于研究在许多国家流行的严重呼吸道综合征。流行病学与实验室研究仍在继续。一种新的冠状病毒已被确定为本病的致病因子。CDC暂行的可疑病例标准着重临床表现和与患者的接触史和疫区旅行史。医务人员、患者家属及社区的感染控制应遵循消毒隔离措施     

Duration of RT-PCR positivity in severe acute respiratory syndrome.

Severe acute respiratory syndrome (SARS) is a highly infectious respiratory infection with a high mortality. The duration of infectivity is unknown. The RT-PCR positivity for SARS-associated coronavirus (SARS-CoV) was followed in 45 virologically confirmed SARS patients. Serial RT-PCRs for SARS-CoV were performed in the nasopharyngeal aspirate, stool and urine of 45 SARS patients who survived until discharge. All patients had at least one site that was positive for SARS-CoV on presentation. Time to RT-PCR conversion was studied in all patients. There were 15 males (33.3%) and 30 females (66.7%), with a mean+/- SD age of 40.7+/-14.7 yrs. The median (range) time of RT-PCR conversion was 30 days (2-81). On discharge from the hospital, 18 (40%) remained RT-PCR positive in at least one site. For patients with positive RT-PCR on discharge, the median (range) time to RT-PCR conversion after discharge was 13 days (2-60). A significant proportion of severe acute respiratory syndrome patients remained RT-PCR positive for severe acute respiratory syndrome-associated coronavirus for a substantial duration after discharge. The clinical significance is unknown and this finding merits further study. It is prudent to advise patients to adhere to strict personal hygiene on discharge until RT-PCR becomes negative.     

Spontaneous pneumomediastinum in patients with severe acute respiratory syndrome.

Spontaneous pneumomediastinum (SP) unrelated to assisted ventilation is a newly recognised complication of severe acute respiratory syndrome (SARS). The objective of the present study was to examine the incidence, risk factors and the outcomes of SP in a cohort of SARS victims from a community outbreak. Data were retrieved from a prospectively collected database of virologically confirmed SARS patients. One hundred and twelve cases were analysable, with 13 patients developing SP (11.6%) at a mean +/- SD of 19.6 +/- 4.6 days from symptom onset. Peak lactate dehydrogenase level was associated with the development of SP. SP was associated with increased intubation and a trend towards death. Drainage was required in five cases. For patients who survived, the SP and/or the associated pneumothoraces took a median of 28 days (interquartile range: 15-45 days) to resolve completely. In conclusion, spontaneous pneumomediastinum appeared to be a frequent complication of severe acute respiratory syndrome. Further research is needed to investigate its pathogenesis.     

北京首批重症急性呼吸综合征患者临床特征及预后分析

目的　探讨重症急性呼吸综合征 (SARS)临床特征 ,分析其预后影响因素。方法　以北京地区首批 34例SARS患者为研究对象 ,观察其临床特征及辅助检查 ,并对 1例死亡患者尸检。结果　患者年龄平均 (33 4± 13 4 )岁 ;潜伏期 2～ 14d ,中位数 4d。发热 (10 0 % )、心悸 (91 7% )、肌痛(79 2 % )、头痛 (70 8% )、腹泻 (73 9% )、咳嗽 (5 8 3% )为主要临床表现。初诊时白细胞计数平均 (4 6± 1 4 )× 10 9/L ,淋巴细胞平均 0 2 7± 0 11,淋巴细胞绝对计数 (1 2 3± 0 4 6 )× 10 9/L ,6 8 4 %病例低于正常。ALT、乳酸脱氢酶、血沉水平升高者分别占 76 2 %、2 8 6 %、4 7 8% ,血清铁、血清白蛋白水平降低者分别为 6 3 2 %、38 1%。 32例有胸部X线检查异常 ,2例CT扫描发现异常。尸检 :肺脏和淋巴组织受累明显。多因素分析显示 ,不良预后独立影响因素是高龄。结论　发热、淋巴细胞和血清铁降低及胸部影像学检查可早期诊断SARS ;年龄为该病预后的独立预测因素。     

Coronary plaque instability in severe acute respiratory syndrome

In his second week of severe acute respiratory syndrome (SARS) illness, a patient developed an unusually complicated course of acute coronary syndrome. One day after initial stabilization of a non-ST-elevated anterior myocardial infarction (MI), he sustained an ST-elevated anterior MI. Eight hours after emergency coronary intervention to the culprit lesion, he developed another ST-elevated MI in the inferior territory. Acute inflammation and cytokine storm in the immunopathological phase of SARS may play a role in coronary plaque instability. Physicians should be alert to this potentially fatal complication and adopt appropriate vigilant and aggressive management strategies.     

SARS患者的低钙血症

25例严重急性呼吸综合征 (SARS)患者入院时血清钙水平 (2 .13± 0 .0 8)mmol/L低于正常。SARS患者低钙血症发病率为 60 .0 %。重症SARS患者低钙血症发生率 (88.9% )明显高于普通SARS患者(4 3 .8% ,P <0 .0 5 )。     

严重急性呼吸综合征的肺组织损伤病理改变

目的 观察严重急性呼吸综合征(SARS)死亡患者的肺部病变特点。方法 采用光镜、组织特殊染色对3例SARS死亡患者的肺组织进行了重点观察。采用兔抗-Fas、鼠抗-PCNA、鼠抗-CD83、CD4、CD8单克隆抗体，经免疫组织化学法对肺及肺门淋巴结等组织进行了检测。结果 肺脏的外观多呈红色或紫红色，镜下显示不同程度的间质渗出性或漏出性炎症和肺泡损伤，肺泡间隔内单个核细胞浸润，肺泡腔内有透明膜形成及凋亡脱落的Ⅱ型肺泡上皮细胞。一些肺泡毛细血管腔内可见纤维素性血栓形成，支气管动脉腔内有血栓栓塞。增宽的肺泡间隔内有纤维素沉积。3例肺泡腔内未见明显地巨细胞浸润。免疫组织化学检测显示，增殖细胞核抗原阳性细胞少见，Ⅱ型肺泡上皮细胞及肺泡间隔、肺门淋巴结内的单个核细胞有较多的Fas抗原表达；与慢性炎性淋巴结相比，SARS患者的肺门淋巴结内淋巴细胞结构破坏、淋巴细胞稀疏、数量明显减少，但CD83及CD8阳性细胞仍较多见，而CD4阳性淋巴细胞少见。脾脏也可观察到淋巴细胞数量的减少，白髓萎缩，出血坏死，表达CD4的阳性细胞减少。结论 严重的肺组织及免疫系统损伤可能导致SARS患者的死亡。     

严重急性呼吸综合征的细胞免疫功能研究

目的　探讨严重急性呼吸综合征 (SARS)患者细胞免疫功能的动态变化及探讨免疫功能与病情进展的关系。方法　选择急性SARS患者 10 7例 ,按照疾病预后分成死亡组和治愈组 ,回顾性分析免疫功能的动态变化及免疫功能在两组间的差异。结果　SARS患者免疫功能在极期下降到最低点 ,呈现一过性免疫缺陷 ,此后迅速恢复。死亡组与治愈组比较 :疾病初期和进展期的细胞免疫功能差异无显著性 (P >0 .0 5) ,两组的CD3 +、CD4+、CD8+在病初和进展期分别为 63 9.14± 2 87.0 8/62 8.63± 3 16.85,2 95.57± 191.0 1/ 3 3 3 .3 3± 188.64,3 0 0 .71± 10 6.76/ 2 51.85± 12 5.92 ,63 5.0 0±449.50 / 790 .0 3± 558.3 0 ,3 72 .0 0± 3 0 3 .3 7/ 4 17.0 9± 3 12 .0 4,2 52 .71± 14 7.44/ 3 3 8.43± 3 0 0 .3 6;极期和恢复期的细胞免疫功能差异非常显著 (P <0 .0 1) ,死亡组和治愈组在极期与恢复期的CD3 +、CD4+、CD8+分别为 3 0 4.0 0± 84.2 6/ 70 1.97± 489.43 ,171.11± 78.84/ 3 99.41± 3 3 2 .40 ,13 3 .2 2±2 4.3 1/ 2 87.71± 199.88,3 4 9.50± 183 .84/ 112 0 .2 9± 565.42 ,2 0 2 .0 0± 10 1.89/ 645.12± 3 76.3 3 ,13 9.79± 87.0 7/ 4 53 .0 9± 2 51.0 6。结论　SARS确实影响机体免疫功能 ,大     

SARS患者甲状腺功能检测分析

测定 8例严重急性呼吸综合征 (SARS)患者血浆甲状腺激素水平。结果显示这些患者的血浆TT3 、FT3 下降 ,rT3 升高 ,符合低T3 综合征诊断。     

Mannose-binding lectin in severe acute respiratory syndrome coronavirus infection

Little is known about the innate immune response to severe acute respiratory syndrome (SARS) coronavirus (CoV) infection. Mannose-binding lectin (MBL), a key molecule in innate immunity, functions as an ante-antibody before the specific antibody response. Here, we describe a case-control study that included 569 patients with SARS and 1188 control subjects and used in vitro assays to investigate the role that MBL plays in SARS-CoV infection. The distribution of MBL gene polymorphisms was significantly different between patients with SARS and control subjects, with a higher frequency of haplotypes associated with low or deficient serum levels of MBL in patients with SARS than in control subjects. Serum levels of MBL were also significantly lower in patients with SARS than in control subjects. There was, however, no association between MBL genotypes, which are associated with low or deficient serum levels of MBL, and mortality related to SARS. MBL could bind SARS-CoV in a dose- and calcium-dependent and mannan-inhibitable fashion in vitro, suggesting that binding is through the carbohydrate recognition domains of MBL. Furthermore, deposition of complement C4 on SARS-CoV was enhanced by MBL. Inhibition of the infectivity of SARS-CoV by MBL in fetal rhesus kidney cells (FRhK-4) was also observed. These results suggest that MBL contributes to the first-line host defense against SARS-CoV and that MBL deficiency is a susceptibility factor for acquisition of SARS.     

Current status of severe acute respiratory syndrome in China

Severe acute respiratory syndrome (SARS), also called infectious atypical pneumonia, is an emerging infectious disease caused by a novel variant of coronavirus (SARS-associated coronavirus, SARS-CoV). It is mainly characterized by pulmonary infection with a high infectivity and fatality. SARS is swept across almost all the continents of the globe, and has currently involved 33 countries and regions, including the mainland China, Hong Kong, Taiwan, North America and Europe. On June 30, 2003, an accumulative total reached 8450 cases with 810 deaths. SARS epidemic was very rampant in March, April and May 2003 in the mainland of China and Hong Kong. Chinese scientists and healthcare workers cooperated closely with other scientists from all over the world to fight the disease. On April 16, 2003, World Health Organization (WHO) formally declared that SARS-CoV was an etiological agent of SARS. Currently, there is no specific and effective therapy and prevention method for SARS. The main treatments include corticosteroid therapy, anti-viral agents, anti-infection, mechanical ventilation and isolation. This disease can be prevented and controlled, and it is also curable. Under the endeavor of the Chinese Government, medical staffs and other related professionals, SARS has been under control in China, and Chinese scientists have also made a great contribution to SARS research. Other studies in developing new detection assays and therapies, and discovering new drugs and vaccines are in progress. In this paper, we briefly review the current status of SARS in China.     

An indolent case of severe acute respiratory syndrome

Severe acute respiratory syndrome (SARS) is a highly contagious and typically rapidly progressive form of atypical pneumonia, which spread from Asia to many parts of the world in early 2003. Clinical diagnosis of SARS requires the presence of unremitting fever and progressive pneumonia despite antibiotic therapy, particularly in the presence of lymphopenia and raised transaminase levels. We report the case of a woman who had undergone a successful allogeneic bone marrow transplant for acute myeloid leukemia. She presented initially with fever and a normal chest radiograph. Her indolent clinical course of SARS was punctuated by resolution of fever, but there was progressive radiologic deterioration and increasing serum antibody titer against SARS coronavirus. Treatment with oral prednisolone and ribavirin normalized her lymphopenia, altered transaminases, chest radiograph and high-resolution computed tomography appearances rapidly. Our experience should alert other clinicians in recognizing this atypical indolent presentation of SARS, to protect health care workers and the community at large and to ensure that these patients are properly treated.     

8例严重急性呼吸综合征死亡病例特点分析

目的总结8例严重急性呼吸综合征（severe acute respiratory syndrome,SARS）死亡病例临床特点,探讨应对突发传染病的教训与经验。方法总结病例的临床表现、影像资料、实验室资料及治疗措施,分析这些因素对预后的影响。结果SARS传染性强,潜伏期短,老年、妊娠及合并基础病患者预后不良。在早期尚未找到有效抗病毒药的情况下,早休息及合理对症治疗很重要。长期过量应用糖皮质激素易致血糖升高、二重感染等致死并发症。结论对新发传染病做到严密隔离、早休息、早期合理治疗,保护好高危人群至关重要。