北京地区250例严重急性呼吸综合征患者临床分析

目的　探讨严重急性呼吸综合征 (SARS)的流行病学特征、临床表现、实验室检查、治疗及预后等特点。方法　回顾性分析北京地坛医院 2 50例SARS患者的临床资料。结果　 2 50例患者的平均年龄 (3 6± 16)岁 ,男 110例 (44 0 % ) ,女 14 0例 (56 0 % )。潜伏期平均 (8± 7)天。主要临床表现 :发热 (10 0 0 % )、咳嗽 (72 8% )、乏力 (70 0 % )。外周血白细胞计数降低者占 2 7 2 % ,淋巴细胞比例降低者占 64 2 %。CD+ 4和CD+ 8计数降低者分别占 91 4%、80 6%。动脉血氧饱和度 (SaO2 )低于 97%者162例 (64 8% )。血清丙氨酸转氨酶 (ALT)升高者 45 2 % ,天冬氨酸转氨酶 (AST)升高者 2 9 4% ,乳酸脱氢酶 (LDH)升高者 42 1% ,肌酸激酶 (CK)升高者 18 3 %。恢复期血清SARS病毒特异性抗体IgG阳性率 69 9%。采用综合治疗 ,使用抗生素、抗病毒药物、激素及免疫增强剂。需要呼吸支持者 196例 ,气管插管或切开机械通气支持治疗者 8例 ,重症患者 81例 (3 2 4% ) ,死亡 2 5例。结论　SARS传染性较强 ,中青年人群患病为主 ,有特征性临床表现 ,采用综合治疗 ,多数患者可取得较好疗效

Clinical analysis of patients with severe acute respiratory syndrome in Beijing area

OBJECTIVE: To study the epidemiological, clinical and laboratory characteristics, treatment and prognosis of patients with severe acute respiratory syndrome (SARS). METHODS: Clinical data from 250 patients with SARS were retrospectively analyzed. RESULTS: The age of the patients were 36 +/- 16, 44.0% (n = 110) were male, and 56.0% (n = 140) were female. The incubation period was 8 +/- 7 days. The most common symptom were fever (100. 0%), cough (72.8%), and fatigue (70.0%). 27.2% of the patients had decreased white blood cell counts. 64.2% of the patients had decreased lymphocytes. 91.4% and 80.6% of the patients had decreased CD(4)(+) and CD(8)(+) cell counts, respectively. 162 patients (64.8%) had decreased SaO(2). Serum ALT, AST, LDH and CK were elevated in 45.2%, 29.4%, 42.1%, and 18.3% of the patients respectively. Serum IgG to SARS virus was positive in 69.9% of the patients at recovery stage. General combination therapy including antibiotics, anti-viral agents, glucocorticoids and immunity-enhancing agents, was used. Artificial ventilation was used in 196 patients including 8 for whom invasive mechanical ventilation was used Eighty-one (32.4%) were diagnosed as having severe type of SARS. 25 patients died of SARS. CONCLUSIONS: SARS is a highly communicable disease and mostly affects youth and people in their prime of life. It has characteristic clinical manifestations. Combination therapy can be very effective for most patients.