SARS患者糖皮质激素治疗后胸部X线影像变化

目的　探讨SARS患者糖皮质激素治疗后胸部X线影像学变化。方法　回顾性分析我院 2 3例经糖皮质激素治疗的SARS患者胸部X线影像学资料 ,其中男 10例 ,女 13例 ,年龄 2 1～ 6 8岁。比较激素治疗前后肺部阴影的变化情况。结果　 2 1例患者肺部阴影在 2 5～ 6 0天内完全吸收或明显好转 ,平均为 4 2 .8± 11.5天 ;2例患者肺部阴影逐渐扩大至两肺弥漫性渗出影死亡。激素治疗后肺部阴影变化可分为四种类型 :① 16例 (6 9.5 % )患者在应用激素后肺部阴影逐渐吸收 ;② 2例(8.7% )患者肺部阴影有所进展 ,3～ 4天后肺部阴影逐渐吸收 ;③ 3例 (13.1% )患者在应用激素 3～ 7天时肺部阴影较前无明显变化 ,之后肺部阴影逐渐吸收 ;④ 2例 (8.7% )患者病变范围未见明显吸收 ,反而逐渐增大 ,最后呈两肺弥漫性渗出影。结论　糖皮质激素治疗后胸部X线影像变化多样 ,对观察疗效和指导治疗有重要临床意义。

The Change of Chest Radiograph in SARS Patients Treated with Glucocorticoid

Objective To study the change of chest radiography of patients with severe acute respiratory syndrome (SARS) after treated with glucocorticoid.Methods The imaging data of chest X-ray radiogram were analyzed in 23 patients with SARS treated with glucocoricoid in our hospital retrospectively. There were 10 men and 13 women in this group, and their aged were 21-68 years. The X-ray findings before and after glucocorticoid treatment were compared to observe the changes.Results The opacity were disappeared completely or improved obviously in 21 patients within 25-60 days(mean 42.8±11.5 days).The X-ray findings showed progressive deterioration until the lungs became completely consolidated and the patients were died in 2 cases. Four patterns of radiographic changes were recognized after treatment with glucocorticoid: type 1 (radiographic gradually improvement) in 16 of 23 patients (69.5%), type 2 (radiographic deterioration to peak lever in 3 to 4 days followed by radiographic improvement) in 2 patients (8.7%), type 3 (static radiographic appearance in 3 to 7 days followed by radiographic improvement) in 3 patients (13.1%), and type 4 (progressive radiographic deterioration) in 2 patients (8.7%).Conclusion The radiographic appearances changes differently after treatment with glucocorticoid. Recognizing these changes is helpful in estimating curative effect and directing treatment.