摘要
目的 探讨 2 0 0 4年广州市散发严重急性呼吸综合征 (SARS)的特点。方法 对 2 0 0 4年确诊的 4例SARS患者的流行病学和临床资料、实验室和肺部影像学检查、预后等进行前瞻性研究。结果 4例均为散发病例 ,分别于 2 0 0 3年 12月 16日至 2 0 0 4年 1月 8日起病。 2例有动物直接接触史 ,但均无食野生动物史。共 2 5 7例接触者均无发病 ,潜伏期不明确。急性发热起病 ,热程 7~11d。均有轻微咳嗽 ,无明显胸闷、气促 ;恶心、呕吐 1例 ,腹泻 1例。 4例患者白细胞及淋巴细胞呈不同程度降低 ,2例外周血T淋巴细胞亚群计数轻微降低。 3例丙氨酸氨基转移酶和天冬氨酸氨基转移酶轻度升高。血氧饱和度均无降低。 1例咽拭子中检测出SARS CoVRNA ,4例血清SARS IgM /IgG较早由阴转阳且滴度在短期内呈 4倍以上升高 ,中和抗体实验阳性。胸片检查均呈多肺叶渗出、实变及毛玻璃样改变。经对症综合治疗预后良好 ,4例均未使用激素及呼吸机。病程为 2 1~ 2 3d。近期随访无并发症发生。结论 2 0 0 4年广州市 4例SARS均为社区获得性散发病例 ,临床表现轻 ,病程短 ,抗体出现早 ,易于治疗并迅速康复 ,无并发症和后遗症 ,未见续发病例。
Objective To explore the clinical characteristics of patients with sporadic severe acute respiratory syndrome in China in 2004. Methods Prospectively study the epidemiological and clinical data, laboratory findings, chest radiograph and prognosis of the 4 cases of SARS occurring in Guangzhou, China in 2004. Results The patients were 3 males and 1 female with the age from 20 to 40 years old. They were all independent sporadic cases distributing in four different districts of Guangzhou city. The onset date was from Dec 16, 2003 to Jan 8, 2004. Their occupations were independent film producer, restaurant waitress, businessman and doctor respectively. The film photographer contacted rats and the waitress contacted cage constrained civet cats within two weeks before the illness. None of the patients had a history of eating wild animal meat. All close contacts (257) did not develop SARS symptoms. The incubation period in these patients was undetermined. All patients started acutely with fever with the highest temperature less than 40 ℃. The fever lasted for 7 to 11 days. All cases had slight cough with little mucus sputum and no patients had panting and shortness of breath. One case had nausea and vomiting, and another had diarrhea. Leucocytopenia and lymphocytopenia were seen in all the patients. Two patients had slightly decreased peripheral blood T lymphocyte count. ALT and AST levels increased slightly in 3 (75%) patients. No desaturation of oxygen was seen in all the patients. SARS CoV RNA was detected by PCR in pharyngo swabs only in one patient. Both SARS IgM and IgG sero conversion occurred earlier in all the patients with the titer increasing for more than 4 folds shortly. Neutralization test was positive in all the patients. Chest X ray in all patients showed infiltrate, consolidation or gross glass like shadows in multi lobes of both lungs. All patients received general anti symptomatic and supportive therapy without using steroid and artificial ventilator. All patients completely recovered. The course of disease is from 21 to 23 days. No sequela and complication were found during the follow up period after the dischargement from hospital. Conclusions The four SARS cases were all community acquired sporadic cases in China in 2004 and were the first reported spontaneous cases in the world. They were relatively clinically mild and the course of disease was relatively short in all the patients. The SARS CoV antibodies in these patients came out early. All the patients recovered quickly and completely without any sequelas and complications.
出处
《中华传染病杂志》
CAS
CSCD
北大核心
2004年第4期225-228,共4页
Chinese Journal of Infectious Diseases
基金
广东省科技局及广州市科技局重大科技攻关项目 (2 0 0 3 Z 0 2 3 0 1)