SARS患者首诊的胸部X线表现

目的分析严重急性呼吸综合征(SARS)首诊患者的胸部X线表现及其在诊断和鉴别诊断中的作用.方法回顾性分析79例SARS患者首诊胸部X线平片,其中男性40例,女性39例;平均年龄(34.1±12.3)岁(15～69岁);平均体温(38.8±0.58)℃.79例患者起病时间至首次胸部X线检查平均时间为(5.8±3.7)d.观察项目包括:病变部位、肺部的基本病变、胸腔积液、心包积液、肺门和纵隔淋巴结增大等.结果79例患者首诊X线胸像阴性者占总例数的45.5%,43例X线胸像阳性者肺内所见均以渗出性病变为主,占阳性总数的81.3%.首诊胸片阳性和阴性者的平均年龄和平均起病时间的比较差异无显著性(P＞0.05).79例患者首次胸片未见有心包积液、肺门和纵隔淋巴结增大.结论SRAS患者的胸部X线表现多以磨玻璃样病变为主,但特异性不强;SARS患者首诊胸部X线阴性者并不少见,且胸部X线阳性者出现时间也可能较晚,应引起临床上的重视.

Initial radiographic manifestations in patients with SARS

OBJECTIVE: To observe initial radiographic manifestations and evaluate its value for the diagnosis and differential diagnosis in patients with severe acute respiratory syndrome (SARS). METHODS: Initial chest radiographs of 79 patients, 15 to 69 years old (mean age 34.1 years, 40 men and 39 women), were retrospectively reviewed in the study. For all patients, average temperature was 38.8 degrees C and mean time from onset of the fever to the time of initial radiographs taken was 5.8 days. Location, abnormal distribution, appearance of lung abnormalities, effusion of pericadiaum and pleura, and lymphadenopathy were observed. Abnormal distribution and associated findings were compared. Differences of mean age, temperature, and the time were statistically analyzed between patients with and without abnormal findings. RESULTS: Initial chest radiographs were normal in 36 of 79 patients (45.5%). Abnormal radiographs in 43 patients (81.3%) showed exudative changes. No significant difference of mean age and day (form onset of the fever to the time of initial radiographs taken) was found between the patients with and without abnormal initial chest radiographs (P > 0.05). No lymphadenopathy, effusion of pericadiaum and pleura were found on the initial chest radiographs. CONCLUSIONS: The main abnormal radiographic appearance of lung in patients with SARS is exudative changes. SARS patients with normal initial chest radiographs are not uncommon and abnormal radiographic findings may appear to be late after onset of fever. Therefore, more attention should be paid in the clinical diagnosis of SARS.