��ͯSARS�ٴ�������Զ����ù۲�

目的了解北京地区儿童严重急性呼吸道综合征(SARS)病例的临床特征和远期随访结果。方法截止2003-07-10,首都医科大学附属北京儿童医院SARS医疗小组收治的以及北京市卫生局科教处提供的北京地区儿童SARS病例共38例,根据卫生部SARS信息系统提供的临床信息总结分析儿童SARS病例的临床特征,在患儿出院后1年半左右,对38例患儿进行随访研究,随访的内容包括:(1)血压测量;(2)血常规检测;(3)肝肾功能检测;(4)肺:所有患儿进行X线胸片和肺功能检测,若二者之一有异常,则进一步进行高分辨CT检测;(5)股骨头X片;(6)心电图和心脏B超;(7)T细胞亚群检测;(8)患儿行为和主观生活质量评估,包括儿少主观生活质量和儿童行为量表;(9)血清冠状病毒特异性IgG抗体检测。结果38例儿童SARS临床表现中,发热率为100%,咳嗽30例(78·9%),咳痰25例(65·8%),气促3例(7·9%),全身中毒症状中,乏力、肌肉关节酸痛和头痛的发生率分别是36·4%、7·9%和18·4%。从实验室检测看,38例儿童SARS中,外周血白细胞<4·0×109/L者8例(21·1%),(4·4~10·0)×109/L者25例(65·8%),>10·0×109/L者5例(13·2%)。血小板减少2例(5·26%)。部分病例肝肾功能和心肌酶轻度异常。共有16例儿童SARS病例家长按期完成随访研究。16病例中,血清抗SARS-CoV-IgG阳性和阴性各8例。血清抗SARS-CoV-IgG阴性和阳性病例的临床特征症状差异无显著性意义。患儿的心肝肾功能、股骨头X片、T细胞亚类均正常,无高血压病例。3例患儿肺功能检查均示轻度异常,表现为FEF50-75轻度减低,R20轻度升高,其中1例行高分辨CT检查,结果正常。共有8例8岁以上患儿进行了儿童行为调查和儿少主观生活质量评估,未见明显的心理和行为障碍存在。结论SARS在儿童并不是一个严重的疾病,其临床表现轻、预后好,远期没有严重的并发症。但其原因还需要进一步研究。

Study of clinical features and long-term outcomes of children''''s SARS cases

??AbstractObjectiveTo investigate the clinical features and long??term outcomes of children??s SARS cases in Beijing.MethodsThere were totally 38 cases of children??s SARS in Beijing area.Information of patients was provided by Science??education Department of Beijing Health Bureau.Patients were followed up with confirmed consensus of their parents or guardians one year and half after the onset of diseases.Items of follow??up included:(1) blood pressure;(2) blood routine;(3) function of liver and kidney;(4) lung function and chest X??ray,and high??resolution computer tomography were needed if lung function or chest X??ray was abnormal;(5) X??ray for femoral head;(6) electrocardiogram and ultrasonic echocardiogram;(7) subgroup of T lymphocyte;(8) Achenbach s Children Behavior Checklist and subjective satisfactory feeling to quality of life;(9) detection of antibodies against SARS??CoV??IgG in sera.ResultsOf 38 children's SARS cases,percentage of fever was 100%,cough 78.9%,sputum production 65.8% and dyspnea 7.9%.Of symptoms of body toxicity reaction,fatigue was 36.4%,arthritis and muscle myalgia 7.9%,and headache 18.4%.Totally 16 pediatric SARS cases with confirmed consensus of their parents or guardians were followed up.Of 16 pediatric SARS cases,8 cases were positive of SARS??CoV??IgG and the others were negative of SARS??CoV??IgG.There were no cases of hypertension.Function of cardia,liver and kidney,X??ray for femoral head and subgroup of T lymphocyte of all patients were normal.Mild dysfunction of lung was observed in three patients with decreased FEF50??75 and increased R20.One of the three patients got high??resolution computer tomography and the result was normal.Children's behavior survey and subjective satisfactory feeling to quality of life were evaluated to eight patients with age over 8.No psychological and behavioral problems were observed.ConclusionChildren's SARS is not a severe disease and has mild clinical manifestations and good outcomes.There are no long??term severe complications in children s SARS cases.