严重急性呼吸综合征合并下呼吸道感染对患者康复期的影响

目的通过对严重急性呼吸综合征(SARS)患者出院后血清特异性抗体IgG、胸片和肺功能的跟踪观察,了解SARS急性期合并下呼吸道感染对其的影响。方法定期跟踪77例SARS患者出院后的血清特异性抗体IgG、胸片和肺功能,将其分为两组继发下呼吸道感染组和非继发下呼吸道感染组,比较两组IgG的动态变化和出院后胸片与肺功能恢复的差异性。结果继发感染组的特异性抗体IgG于第2周高于非感染组,于第8周和第10个月感染组低于非感染组。两组数据均于发病后逐渐增高,于第4个月达最高峰,随后逐渐下降,与发病后时间呈高度相关(r=0811),配对t检验显示感染组的IgG明显低于非感染组。病程第6个月,非感染组66例中,42例胸片已恢复正常;感染组19例中,仅1例胸片正常。10例非感染组中,仅1例有轻度弥散功能障碍;7例感染组中,重度限制性通气功能障碍和重度弥散功能障碍1例,中度1例,轻度3例。结论SARS患者急性期合并下呼吸道感染者,康复期血清特异性抗体比非感染组低,肺部病灶吸收速度和肺功能恢复速度较均缓慢。

The effects of secondary infections of lower respiratory tract on the changes of severe acute respiratory syndrome (SARS)-IgG,chest X-ray films and lung function tests in convalescent patients of SARS

Objective To follow up severe acute respiratory syndrome (SARS)-IgG,X-ray chest films and lung function tests in convalescent patients with SARS and assess the effects of secondary infections of lower respiratory tract.Methods 77 convalescent patients with SARS were divided into two groups:non-secondary infection and secondary infection groups.Serum SARS-IgG,X-ray chest films and lung function tests of the patients were followed up every 3 months after their discharge from the hospital.The results of the two groups were compared.Results Serum SARS-IgG in secondary infection group was significantly higher than that in non-secondary infection group in the second week after onset of SARS,but it is lower than that in non-secondary infection group in the 8~th week and in the 10~th month.The serum SARS-IgG in both groups increased gradually after the onset of SARS and reached the highest levels in the 4~th month and then decreased gradually.Paired-samples t test revealed that serum SARS-IgG in the secondary infection was significantly higher than that in non-secondary infection group.In the 6~th month after onset,Chest X-ray films showed that 42 of 66 cases in non-secondary infection group and only 1 of 10 cases in secondary infection group were normal.6 months later,only 1 in 10 cases of non-secondary infection group still demonstrated a mild abnormal lung function but in secondary infection group,the disturbances were 5 in 7 ie.1 severe,1 middle,and 3 mild.Conclusion During convalescence of SARS,the patients with secondary infection had lower levels of serum SARS-IgG and slower recovery of the radiographic changes and lung function than those without secondary infection.