基础疾病对严重急性呼吸综合征患者预后的影响

回顾性分析宣武医院2003年5月至6月收治的212例严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的临床资料,观察患者发病前合并的基础疾病与死亡及出院时胸片吸收情况的关系。发现有基础疾病的患者,病死率(20.7%)显著高于无基础疾病患者(4.5%,P=0.000);合并2种或者2种以上基础疾病的患者,病死率明显高于合并一种基础疾病及无基础疾病的患者(P值分别为0.008、0.000);在糖尿病、高血压、冠心病、脑血管疾病、慢性阻塞性肺病、肝炎/肝硬化6种疾病中,采用Logistic回归分析,发现脑血管病、肝炎/肝硬化是SARS患者死亡的主要危险因素(P值分别为0.000、0.001),糖尿病未明显增加SARS患者的病死率。治愈的SARS患者,合并基础疾病组胸片遗留病变者(60.4%)显著高于无基础疾病组(29.9%,P=0.001)。提示SARS患者合并基础疾病者病死率明显升高,随着合并的基础疾病的增多,病死率明显上升。肝炎/肝硬化及脑血管病是死亡的危险因素;基础疾病使SARS患者肺部损伤加重、恢复慢。糖尿病未明显增加SARS患者的病死率,提示糖尿病可能对患者避免SARS引起的急性肺损伤起一定作用。

Effects of Underlying Disease on the Prognosis in Patients with Severe Acute Respiratory Syndrome

The objective was to study the effects of underling diseases on the prognosis in patients with severe acute respiratory syndrome(SARS).All the212patients admitted to Xuanwu hospital from May to June in2003were studied retrospectively.The mortality in patients with underling diseases(20.7%)was significantly higher than patients without underlying diseases(4.5%).There was a higher mortality in patients with or above two underling diseases.By Logistic regression,among diabetes mellitus(DM),hypertension,coronary heart disease,chronic obstructive pulmonary disease(COPD),cerebral vessel disease(CVD)and hepatitis/hepatocirrhosis,CVD(P=0.000)and hepatitis/hepatocirrhosis(P= 0.001)were main death-related risk factors.The mortality seemed not to increase in SARS patients with DM.In recovered patients,60.4%of the patients with underling disease had a non-completely absorbed x-ray,and29.9%of the patients without underling disease.SARS patients with underling disease had a significant high mortality.With more kinds of underling diseases the mortality enhance greatly.CVD and hepatitis/hepatocirrhosis are main death-related risk factors.SARS patients with underling disease have a severer damage on lung and their recovery are slower than the others.The mortality did not seem to increase in SARS patients with DM.