对严重急性呼吸综合征的再认识——胸部影像特点结合临床资料对早期诊断严重急性呼吸综合征的意义

目的:分析2004年在北京发生的严重急性呼吸综合征(SARS)早期胸部影像特点及相对应的临床表现,并对比2003年资料,探讨其早期的表现,为临床提供借鉴。方法:对2004年在北京地坛医院住院的7例SARS患者的临床、化验、胸片及高分辨CT(HRCT)资料进行回顾性分析。结果:6例均急性起病,体温>38℃,无上呼吸道卡他症状,发热第1周出现肺部局灶或多段分布的阴影,阴影常呈类圆型,多表现为磨玻璃影,其内可见小叶间隔增厚,部分表现肺实变影,病灶内可见支气管气像,无坏死或空洞病灶,无肺门及纵隔淋巴结肿大,无胸腔积液。发热的第2周,肺部阴影迅速扩大,或发展至对侧,出现呼吸困难,在出现肺部阴影进展时,给予糖皮质激素,阴影在2~3d内明显吸收,临床症状改善。病程早期,白细胞不增高,淋巴细胞和血小板偏低,血乳酸脱氢酶(LDH)在第2周明显增高,丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)在第2或第3周开始增高。结论:对于急性起病、发热、白细胞不高、胸部HRCT表现类圆型磨玻璃阴影伴小叶间隔增厚或肺实变、短期抗生素治疗无效的患者应提高警惕,注意排除SARS。

Recognition of severe acute respiratory syndrome: the significance of the chest radiographs and high-resolution CT combined with clinical manifestations in diagnosing early SARS

Objective: To assess the early chest radiographic and high-resolutio n CT(HRCT) findings as well as corresponding clinical manifestations in patients with severe acute respiratory syndrome (SARS) occurred in 2004 and compare with those in 2003. Method: The clinical presentation, laboratory tests, chest radiogr aphic and HRCT findings in 7 cases of patients with SARS were retrospectively an alyzed. Result: Six patients had acute fever (>38℃) without upper respiratory sy mptoms. in the first week of fever, they all had opacities on HRCT. Round, groun d-glass opacification associated with mild thickening of the interlobular septa or consolidation was the predominant HRCT feature, no necrosis or cavities lymph adenopathy (hilar and mediastina) and pleural effusions were found. The WBC coun t was normal, and the lymphocytes and platelets usually were reduced in early st age. Conclusion: The patients with acute fever, normal WBC count, ground-glass o p acification associated with mild thickening of the interlobular septa or consoli dation in HRCT, and resistant antibiotics may suffer from SARS.