Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 -20,2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3)the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8% ) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24.4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological featuresEarly recognition, prompt isolation, and appropriate therapy are the key to combate this infection.     

A retrospective study of 78 patients with severe acute respiratory syndrome

Objective To summarize the clinical features of severe acute respiratory syndrome (SARS) and to discuss diagnosis and management of the disease. Methods A retrospective study was conducted on 78 cases of SARS referred to the Guangzhou Institute of Respiratory Diseases (GIRD) between December 22, 2002 and near the end of March 2003. Items reviewed cover all data concerning clinical manifestations, laboratory investigation and radiology. Results The patients in the study consisted of 42 males and 36 females, aged 20-75 yrs (mean age 37.5±11.6 yrs), including 44 affected health-care professionals. Clinical symptoms seen in the group were fever (100.0%), cough (88.5%), and dyspnea (79.5%). There were 12 cases (15.3%) with WBCs <4.0×10(9)/L, 49 cases (62.8%) ranging between （4.0-10.0）×10(9)/L and 17 cases (21.8%) over 10.0×10(9)/L. The average was（7.58±4.96）×10(9)/L, with 0.75±0.14 (neutrophil) and 0.18±0.11 (lymphocyte). Chest films and CT scanning revealed changes related to pneumonia. The transmission of the disease was likely via close contact with contagious droplets. The prevalences of acute lung injury (ALI, in 37cases) and acute respiratory distress syndrome (ARDS, 21 out of 37 cases) were considerably high among the patients. Seven patients who developed ARDS complicated with multiple organs dysfunction syndrome (MODS) died. Conclusions A history of close contact, fever, sign of pneumonia by X-ray and normal-to-lowered WBC counts are favorable for the diagnosis of SARS. Recognition of ALI as the important index for critical SARS and comprehensive supportive management are of paramount in decreasing the mortality of the disease.     

Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance. Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls. Results The numbers of CD3+, CD4+, and CD8+ lymphocytes all significantly decreased in acute phase of patients with SARS ［(722±533)/μl, (438±353)/μl, (307±217)/μl)］ compared with those in normal controls ［(1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0.01)］, which was different from what we observed in patients with AIDS who had decreased CD4+ ［(296±298)/μl］ but increased CD8+ ［(818±566)/μl］ counts. The counts of CD3+,CD4+, and CD8+ lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4+ counts less than 200/μl. As the patients’ condition improved, CD3+, CD4+, and CD8+ counts gradually returned to normal ranges. Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.     

250例SARS患者肝功能损害的临床分析

目的探讨严重急性呼吸综合征(SARS)患者肝功能损害的一般规律.方法收集250例确诊SARS患者病程第1～6周的肝功能结果,分析总结SARS病程中各指标的变化规律.结果PA在SARS病程的1,2周有明显下降(异常率分别为84%和64%),但很快恢复正常;TP和ALB在病程中均有一定比例的降低,A/G比值下降较明显(异常率均保持在50%以上).ALT病程第1周有52%的患者升高,第3周异常率达到87%,之后开始逐渐回落;AST的异常率及升高幅度均较ALT明显低(整个病程中异常率均＜50%).GGT在病程第3～5周有比较高的异常率(32%,40%和28%).CHE在病程第1周有29%的患者降低,第5周异常率达到46%,第6周开始稍有回升.TB,DB,TBA,ALP和LAP在整个病程中均无明显改变.结论SARS患者在病程早期即有明显的肝功能损害,且恢复较慢,提示在临床诊治过程中要注意护肝治疗.     

严重急性呼吸综合征682例临床分析

目的探讨严重急性呼吸综合征(severe acute respiratory syndrome,SARS)的临床特点.方法回顾性统计分析北京小汤山医院收治的682例SARS临床病例资料.结果682例SARS患者的年龄分布于13～76岁.356例(52.2%)有明确的接触史,有171例(25.1%)发病前曾到过医院.677例(99.3%)患者出现发热,5例患者体温正常.其它主要症状包括咳嗽(44.3%)、气促(12.2%)、腹泻(8.9%);外周血白细胞计数正常或降低占87.4%;ALT和CPK升高的比例分别为16.4%、2.5%;全部患者都有肺部病变,累及双肺占69.8%;死亡6例.结论该病有较强的传染性,医院是重要的传播场所;发热、咳嗽、胸片异常及外周血白细胞正常或降低是该综合征的主要临床特点.     

院内感染SARS医护人员特异性IgG抗体水平的影响因子

目的探讨院内感染严重急性呼吸道综合征(SARS)医护人员特异性IgG抗体水平的影响因素。方法回顾性收集20例院内感染SARS医护人员的人口特征、流行病学史、临床表现、实验室检查和主要治疗措施等资料作为研究因素,采用间接酶联免疫吸附试验(ELISA)检测20例SARS患者在发病后第1～36周的血清特异性IgG抗体。分类变量的研究因素比较不同结局患者之间抗体水平采用方差分析;通过一元线性回归、逐步回归分析和偏相关分析数值变量的研究因素与抗体水平之间的关系。结果SARS特异性IgG抗体水平在女性患者高于男性患者,结果有统计学意义(P=0.044);与患者在病程中的最高中性粒细胞计数呈中等程度负相关(偏相关系数=-0.636,P=0.008);与病毒唑治疗的总剂量呈高度正相关(偏相关系数=0.811,P=0.000)。结论SARS特异性IgG抗体水平的影响因素可能与病毒在体内被抑制、病毒血症的持续时间和患者发病后的中性粒细胞反应水平有关,SARS特异性IgG抗体水平与性别的关系值得进一步探讨。     

105例传染性非典型肺炎X线临床特征

[目的]报道传染性非典型肺炎(SARS)的X线的临床特征。[方法]分析105例SARS的X线胸片表现。所有病人均为本院2003年1月30日至3月31日诊治的患者,均符合我国卫生部的临床诊断标准,有完整的胸部X线照片资料。按病变早期表现及进展情况将其分为两个类型。①渗出型:由肺内局限或多发病灶发展至弥漫分布。②间质型:以肺部间质性炎症为早期主要表现,其后或可出现肺实质渗出性病变。[结果]75例SARS表现为肺内渗出性病灶,25例早期呈间质性炎症,随后出现明显肺内实变。5例主要表现为肺间质性炎症。首次发现肺内病变至病变完全吸收时间,为7～46d,平均19d。[结论]SARS的X线影像学表现以肺实质渗出性病变和间质性炎症为主,首诊后7～10d达高峰。大部分病人肺内病变可完全吸收,目前尚未见有后遗症。     

Cardiovascular complications of severe acute respiratory syndrome

Background and Aims

Severe acute respiratory syndrome (SARS) is a virulent viral infection that affects a number of organs and systems. This study examined if SARS may result in cardiovascular complications.

Methods and Results

121 patients (37.5 (SD13.2) years, 36% male) diagnosed to have SARS were assessed continuously for blood pressure, pulse, and temperature during their stay in hopsital. Hypotension occurred in 61 (50.4%) patients in hospital, and was found in 28.1%, 21.5%, and 14.8% of patients during the first, second, and third week, respectively. Only one patient who had transient echocardiographic evidence of impaired left ventricular systolic function required temporary inotropic support. Tachycardia was present in 87 (71.9%) patients, and was found in 62.8%, 45.4%, and 35.5% of patients from the first to third week. It occurred independent of hypotension, and could not be explained by the presence of fever. Tachycardia was also present in 38.8% of patients at follow up. Bradycardia only occurred in 18 (14.9%) patients as a transient event. Reversible cardiomegaly was reported in 13 (10.7%) patients, but without clinical evidence of heart failure. Transient atrial fibrillation was present in one patient. Corticosteroid therapy was weakly associated with tachycardia during the second (χ² = 3.99, p = 0.046) and third week (χ² = 6.53, p = 0.01), although it could not explain tachycardia during follow up.

Conclusions

In patients with SARS, cardiovascular complications including hypotension and tachycardia were common but usually self limiting. Bradycardia and cardiomegaly were less common, while cardiac arrhythmia was rare. However, only tachycardia persisted even when corticosteroid therapy was withdrawn.     

传染性非典型肺炎的临床X线表现分析--附32例报告

目的：探讨传染性非典型肺炎的临床及X线表现特征，提高对本病的认识。方法：依据广东省传染性非典型肺炎诊断标准，总结经临床及X线诊断的传染性非典型肺炎32例，分析其临床、X线表现特征。结果：32例均有发热，21例干咳，13例有全身酸痛、乏力，4例患以发热，腹痛、腹泻为主要症状；29例血白细胞正常或降低。胸片表现可分为三期：即肺间质性炎变期(25例)，肺实变期(32例)、吸收消散期(转归期)。结论：本病具有一定的临床特点，综合：分析X线表现和实验室检查，可作出传染性非典型肺炎的诊断。     

严重急性呼吸综合征患者的胸部X线表现

目的：分析和总结严重急性呼吸综合征(SARS)患者的胸部X线影像特点，为SARS的临床诊断和治疗积累资料并提供参考依据。方法：回顾分析2003年3月5日至3月30日临床确诊的28例SARS患者床边胸部X线表现，并对各病例急性期和恢复期的X线表现进行了对比分析。结果：在发病的急性期，13例呈单个片状影或小淡片状影及3例呈同侧肺野2个淡片状影表现者，病变均位于肺周边部；6例片状影在肺中心部位(近肺门旁)；6例双侧片状影；4例有两肺广泛片状影。在疾病的恢复期，急性期肺部病变范围小的l9例病灶完全吸收；病变较大的9例，6例可见索条影，另3例病变广泛者死亡。结论：SARS患者的胸部X线表现为多种实变阴影，其中单发小淡片影多位于肺周边部位且容易吸收；双肺及广泛实变影多位于中下肺野且吸收较慢。本研究结果初步提示SARS患者胸部病变范围与其预后有关。     

SARS患者白细胞形态学观察

目的：观察不同病程的严重急性呼吸综合征(SARS)患者白细胞形态的变化。方法：对不同病程SARS患者的血涂片进行形态观察和分析。结果：SARS患者发病期间，其粒细胞比例明显升高，淋巴细胞明显减少，而且出现核仁及多核仁现象，随病程进展，粒细胞、淋巴细胞的比例逐渐恢复至正常范围，有核仁的淋巴细胞也随之减少至消失，均为正常成熟的淋巴细胞。结论：SARS患者发病期间，外周血涂片白细胞分类中，中性粒细胞(分叶核)比例升高，淋巴细胞比例明显减少，随病程进展出现的核仁淋巴细胞减少，血细胞比例、形态恢复正常。     

后"非典"时期"非典"的鉴别诊断

目前全国内地每日新增传染性非典型肺炎(SARS)临床诊断病例不足10例,已进入后“非典”时期。SARS属于呼吸道传染病之一,具有临床表现、肺部体征及胸部影像学不一致的特点。在没有SARS流行期间也存在“非典型肺炎”(AP),因此在后“非典”时期加深对SARS发病率及临床演变过程的认识,加强对具有相似临床表现特点的疾病如AP、流感病毒性肺炎、肺结核、肺真菌性肺炎等的鉴别诊断,做好同步化的信息资源共享及加强基层一线医疗人员对SARS与AP的认识与培训,对及时发现SARS患者并避免SARS的“过度诊断”是非常重要的。采用临床多专业专家联合会诊是SARS诊断与鉴别诊断的关键,也是对新出现的传染性疾病临床诊断治疗以及预防和隔离的一种有益尝试。     

SARS患者恢复期传染性的随访调查

目的：了解严重急性呼吸综合征(SARS)恢复期患的传染性．方法：采用统一制定的流行病学随访调查表,在《北京市SARS流行病学个案调查数据库》中随机抽取300例2003-04／2003-05报告的SARS病例进行恢复期(出院后mo)电话随访调查,建立数据库进行统计学和流行病学分析．结果：随机抽取300例中,随访到133例(占44．3％)确诊SARS的恢复期患,失访167例(占55．7％),实际随访率为70．0％．133例SARS患中男女性别比为1：1．2,年龄在15—66yr之间．临床表现发热133例(100％),咳嗽96例(72．2％),X线胸片肺炎特征94例(70．7％),白细胞总数减少89例(66．9％),畏寒73例(54．9％),乏力47例(35．3％),头痛31例(23．3％),全身酸痛28例(21．1％),咳痰13例(9．8％)．出院后进行隔离125例(94．0％),隔离时间为14d98例(78．4％)．所采取的隔离措施可分为6种,措施组合共有11种．恢复期患的密切接触中被感染人数为0．结论：以卫生部颁发的《传染性非典型肺炎病例出院参考标准》为准出院的SARS患在恢复期无论是否采取相应的隔离措施均未发现有明显的传染性．     

糖皮质激素治疗对SARS患者胸部X线片变化影响的临床研究

目的：探讨严重急性呼吸综合征(SARS)患者胸部X线片(胸片)动态变化与糖皮质激素治疗的关系。方法：对4例SARS和疑似SARS患者在其他治疗方案相同的情况下应用糖皮质激素治疗，动态观察胸片变化情况。结果：胸片病灶呈进行性发展，高峰在发病第8～12天，应用糖皮质激素治疗后病灶无吸收。结论：胸片改变可能不是应用糖皮质激素的指征，也不能作为应用剂量和疗程的指导指标。     

SARS患者的体温变化规律及临床对照研究

目的 探讨SARS病人住院后的体温变化规律,探讨糖皮质激素类药物治疗对SARS患者体温的影响。方法 测定94例SARS[分为激素治疗组(35例)和非激素组(59例)]和200例其他疾病[间质性肺炎(65例)、普通肺炎(78例)、上呼吸道感染(57例)]的体温,并观察激素治疗对SARS患者体温的影响。结果 4种疾病患者的平均体温均在住院后7日内有明显的下降患者(P<0.001),7日后平均体温波动较小,且基本在正常体温范围。SARS患者的体温在各个时间点均高于其他疾病(P<0.03),幅度在0.2~0.5℃之间。SARS体温的变化趋势与其他疾病相近(P=0.271)。在每日4个测体温时间,即6、10、14、18时,以14时的体温最高,显著高于其他3个时刻(P<0.001)。激素治疗前,SARS患者两亚组体温无显著差异(P=0.482),治疗后亦无显著差异(P=0.180)。SARS患者住院后的热程为(3.01±4.05)d、间质性肺炎患者为(1.68±3.19)d、普通肺炎为(2.09±2.40)d、上呼吸道感染者为(1.27±1.48)d。热程的整体检验有显著差异,SARS的热程最长。结论 住院后7d内,4种疾病患者每日体温以14时最高;SARS患者的体温显著高于其它疾病;SARS患者是否接受激素类药物治疗对体温影响不显著;SARS住院后的热程最长。     

SARS患者的体温变化规律及临床对照研究

OBJECTIVE: To explore the patterns of temperature changes of patients with the severe acute respiratory syndrome (SARS) and the effect of glucocorticoid hormone on the temperature of these patients. METHODS: The clinical data of 94 SARS cases treated during the outbreak of SARS in South China in 2003 were collected for a retrospective review. According to different treatment regimens, the patients were divided into hormone group (n=35) and non-hormone group (n=59). The control groups consisted of 65 patients with interstitial pneumonia, 78 with bacterial pneumonia and 57 with upper respiratory tract infection. The changes in body temperature were compared between the SARS patients and those with other respiratory diseases and the effect of glucocorticoid hormone on controlling body temperature of the SARS patients was explored. RESULTS: The body temperature of patients with the 4 diseases all exhibited obvious reduction 7 days after hospitalization (P<0.001) with only subsequent mild fluctuation within the basically normal range. At each time point of measurement, the body temperature of SARS patients was significantly higher than that of patients with other diseases (P<0.03), with a fluctuation of 0.2 to 0.5 degrees C; and following a pattern of variation similar to those of the other diseases. Of the 4 time points of daily measurement, namely 6, 10, 14 and 18 o'clock, the temperature measured at 14 o'clock was significantly higher than those at the other 3 time points (P<0.001). Hormone therapy did not significantly affect the temperature of SARS patients (P=0.180), who had longer duration of high fever. CONCLUSION: SARS patients have higher body temperature and longer duration of high fever. Hormone therapy may not produce significant effect in controlling the temperature of SARS patients.     

SARS患者首诊的胸部X线表现

目的分析严重急性呼吸综合征(SARS)首诊患者的胸部X线表现及其在诊断和鉴别诊断中的作用.方法回顾性分析79例SARS患者首诊胸部X线平片,其中男性40例,女性39例;平均年龄(34.1±12.3)岁(15～69岁);平均体温(38.8±0.58)℃.79例患者起病时间至首次胸部X线检查平均时间为(5.8±3.7)d.观察项目包括:病变部位、肺部的基本病变、胸腔积液、心包积液、肺门和纵隔淋巴结增大等.结果79例患者首诊X线胸像阴性者占总例数的45.5%,43例X线胸像阳性者肺内所见均以渗出性病变为主,占阳性总数的81.3%.首诊胸片阳性和阴性者的平均年龄和平均起病时间的比较差异无显著性(P＞0.05).79例患者首次胸片未见有心包积液、肺门和纵隔淋巴结增大.结论SRAS患者的胸部X线表现多以磨玻璃样病变为主,但特异性不强;SARS患者首诊胸部X线阴性者并不少见,且胸部X线阳性者出现时间也可能较晚,应引起临床上的重视.     

严重急性呼吸综合征合并肝损害的临床及病理研究

目的研究严重急性呼吸综合征(SARS)合并肝损害的临床及病理学特征。方法在病程不同时期,动态观察60例SARS患者肝功能指标变化情况,比较SARS重症组病例与普通组病例的肝损害差异。结果76.7%患者ALT升高(146.3±118.3)u/L、40.0%患者AST升高(81.3±29.8)u/L,30.0%患者Bil升高(35.3±15.6)μmol/L;病程第2周肝损害最多见。SARS重症组ALT,AST和Bil异常升高率高于普通组,但仅AST差异有显著性。激素治疗组与非激素治疗组间肝功能异常发生率的差异并无显著性。约93.5%患者经常规保肝治疗3周后肝功复常。1例尸检显示肝脏广泛轻度非特异炎症反应。结论SARS病人合并肝脏损伤相当普遍,表现为转氨酶的轻中度升高,少部分病例伴有胆红素的轻度异常,适当保肝治疗是必须的,也是有效的。     

传染性非典型肺炎流行病学特征及临床诊疗措施的初步探讨

目的　探讨传染性非典型肺炎的流行病学、临床诊断及治疗 ,为防治该病提供经验和依据。方法　采用回顾性分析的方法对本院所收治的传染性非典型肺炎病例进行分析。结果　 6例患者平均年龄 2 8.8岁 ,有明显接触史者 1例 ,呈聚集发病者 3例 ,无医务人员感染 ,均于 4月份发病 ;全部治愈。结论　传染性非典型肺炎是一种新的传染病 ,临床上以发热、咳嗽、白细胞总数正常或下降、胸片渗出性改变为特点 ,其流行病学特点、诊断与治疗方面需进一步认识     

重症SARS患者的临床特点与治疗经验

目的 :探讨重症SARS患者的临床特点及治疗上的特殊性。方法 :回顾性分析我院SARS ICU收治的 36例重症SARS患者的临床资料。结果 :36例重症SARS患者中 ,18例 (5 0 % )年龄 >5 0岁 ,5 8.3%的患者有家庭聚集性发病倾向 ,6 1.1%的患者有明确的基础疾病 ,97.2 %的患者发病初期有明确的高热症状 (≥ 38℃ ) ,83.3%、72 .2 %、5 5 .6 %及 4 4 .4 %的患者分别存在淋巴细胞亚群、心肌酶、肝功及血糖的异常 ,77.8%的患者有X线胸片双肺同时受累的改变 ,86 .1%的患者治疗中使用了肾上腺糖皮质激素 ,30 .6 %及 13.9%的患者救治过程中分别使用了无创或有创通气方式 ,4 1.7%的患者治疗过程中出现了不同程度的合并症。结论 :重症SARS患者病情复杂 ,治疗难度大 ,及早联合治疗能收到很好的临床效果。