SARS肺部炎症演变规律及动态分布特征的探讨

目的通过对SARS患者在干预条件下胸片的研究,揭示SARS肺部炎症演变规律和动态分布特征.方法对参加国家科技部"十五"863重大项目"中西医结合治疗SARS临床研究"的北京地区11家医院入组患者的胸片,通过进行数字化采集,定量评判方法统一判读,建立SARS胸片数据库,再进行统计分析和描述.结果对361例SARS患者的1561张胸片的研究表明,①胸片总积分与肺部炎性病灶的动态分布呈双峰形,普通型第1峰出现在发病第16天,重型在发病第13天;第2个小的、短暂的高峰,普通型出现在发病第25天,重型在发病第19天以后进入恢复的平台期.②SARS的肺部炎症病灶多出现在中、下肺野,以下肺居多;发病8～14 d,右下肺多于左下肺,发病15 d以上左中肺多于右中肺,经统计学检验有显著性差异.③SARS肺部炎症的轻重程度随着年龄的增长呈现愈加严重的趋势.结论 SARS患者的肺部炎症随着病程的进展,其动态演变和病变部位的分布呈现出一定的规律性;不同性别和年龄的SARS患者,肺部炎症具有轻重程度上的差异性.

Regularity of the Development of Pulmonary Inflammation in SARS:Investigation into the Characteristics of Its Dynamic Distribution

Objective To reveal the regularity of the development of pulmonary inflammation in SARS and the characteristics of its dynamic distribution. Method The chest X-rays of the patients from 11 hospitals in Beijing area,which were included in the Clinical Study of Treatment of SARS by Therapies of the Integration of TCM and Western-Style Medicine,one of the 863 key projects sponsored by PRC Ministry of Science and Technology,were digitally processed and quantitatively discriminated on a uniform basis in order to establish a database of chest X-rays of SARS patients. The data in the database were then analyzed and described. Results The study on 1561 chest X-rays of 361 SARS patients showed that (1) the sum integral of the chest X-rays and the dynamic distribution of pulmonary inflammation foci appeared to be with double peaks. The first peak appeared on the 16th day after the outbreak in the common type of SARS,and it appeared on the 13 th day after the outbreak in the severe type of SARS;the second small transitory peak appeared on the 25 th day after the outbreak in common type,and it appeared on the 19 th day after the outbreak in the severe type;afterwards,the convalescence followed;(2) SARS pulmonary inflammation foci appeared mostly in the middle and inferior fields of the lungs,especially in the inferior field;foci in the inferior field of the right lung were found to be more than those in the inferior field of the left lung from the 8 th day to 14 th day after the outbreak,and the foci in the middle field of the left lung were found to be more than those in the middle field of the right lung,which showed a statistically significant difference;(3) the severity of SARS pulmonary inflammation tended to be raised following the increase in the age. Conclusion The dynamic development and the distribution of the foci of the pulmonary inflammation in SARS patients are with certain regularity,and the severity of the pulmonary inflammation are found to be different in SARS patients of different sexes and ages.