严重急性呼吸综合征合并神经精神损害的临床研究

目的　对严重急性呼吸综合征 (SARS)合并神经精神损害的临床特点进行分析总结。方法　回顾分析 32 5例SARS病例 ,其中 173例出现神经精神症状 ,总结分析其临床资料。结果　①SARS神经精神症状发生率约 5 3 2 % ,主要有以下几类 :头痛 116例 (6 7 1% ) ,头晕 5 0例 (2 8 9% ) ,意识障碍 18例 (10 4 % ) ,精神障碍 8例 (4 6 % ) ,伴神经系统局灶定位体征者 1例 (0 6 % ) ,抽搐 2例(1 2 % ) ,情感障碍 5 3例 (30 6 % ) ,其中焦虑 35例 (2 0 2 % ) ,抑郁 11例 (6 4 % ) ,自杀倾向 2例(1 2 % ) ,恐惧 13例 (7 5 % )。② 32 5例中 ,重症SARS 5 6例 ,伴发神经精神损害者 4 7例 ,其发生率明显高于轻症 (P <0 0 1)。③ 4例病例眼底检查显示视乳头边缘欠清晰 ,生理凹陷存在 ,静脉充盈。④2例死亡病例尸体解剖脑组织病理显示 :脑组织出现不同程度的水肿 ,局部神经纤维出现脱髓鞘现象。结论　SARS神经精神损害症状多样 ,与病情轻重显著相关。病理检查可见脑水肿及神经元脱髓鞘等损害。

Clinical analysis of neuropsychiatric involement in severe acute respiratory syndrome

Objective To investigate the clinical features of severe acute respiratory syndrome (SARS) with neuropsychiatric involement .Methods The clinical data of 173 patients of SARS with neuropsychiatric involement were retrospectively reviewed.Results (1) The incidence of neuropsychiatric involement of SARS is about 53.2%. The manifestations mostly consist of: headache 67.1%,dizziness 28.9%,consciousness disorder 10.4%,mental disorder 4.6%,focal manifestations 0.6%,seizures 1.2%, affective disorder 30.6%,in which anxiety 20.2%,depression 6.4%,tendency of committing suicide 1.2%,phobia 7.5%.(2) The number of serious cases with neuropsychiatric involement were much more than those of slight cases,P <0.01.(3) Ophthalmoscopic examination was performed for four patients and showed that the outline of optic disc was blurred,and the retinal veins were congestive. (4) Pathological characteristics of 2 cases: edema of the perivascular tissue and vascular wall of the small veins accompanying with mononuclear cells and lymphocytes infiltration,neuron degeneration and demyelination distributing in the brain.Conclusions The manifestation of neuropsychiatric involement is variable,and is associated with the severity of SARS. The typical pathological change is edema,localized necrosis and neuron degeneration and demyelination.