不同传播代重症急性呼吸综合征患者临床特征的比较

Comparison of clinical features of severe acute respiratory syndrome among different transmission generations

目的 探讨不同传播代重症急性呼吸综合征 (SARS)患者的临床过程有无差异。方法比较不同传播代SARS患者的临床特征。结果 不同传播代SARS患者在年龄、性别、潜伏期以及住院时间等均无明显差异 (P >0 0 5 )。随着传播代的递增 ,SARS患者初始发热体温有所降低 (P <0 0 5 ) ,伴有咳嗽的病例数减少 (P <0 0 5 )。最高体温及白细胞降低在三代患者之间无明显差异 (P >0 0 5 )。肺部病变初始出现至基本或完全吸收的时间缩短 (P <0 0 5 )。病程中最大受累肺野数目及肺部病变初始出现至发展到顶峰的时间在三代患者之间无明显差异 (P >0 0 5 )。氧疗方式及抗生素种类的选择在三代患者之间无明显差异 (P >0 0 5 )。结论 随着传播代的递增 ,SARS患者的临床表现稍有减轻 ,提示SARS冠状病毒短期内连续传播其致病力并无明显降低。

Objective To investigate the differences among various transmission generation of severe acute respiratory syndrome (SARS) by comparing the corresponding clinical data. Methods The clinical data of 84 patients with SARS were retrospectively studied,66 women and 18 men,mean age (29.2± 10.3)years old,96.4% of whom were health care workers. All subjects had exposure to a source patient and the epidemic progressively propagated in a short time. For the infectious chain,we defined these patients who had exposure to a source patient as the primary cases,which included 35 patients (41.7%). Patients who got the disease by exposure to the primary cases were defined as secondary cases,which included 34 patients (40.5%). Similarly,the tertiary cases included 15 patients (17.9%). Results (1)No statistical differences in age,sex ratio,incubation period and hospitalization duration among various infectious generations were found (P>0.05). (2) With descending in infectious generations,the initial temperature lowered,and cases with cough decreased (P<0.05) with no statistical differences in the peak temperature,other accompanying symptoms and leukopenia (P>0.05). (3)With descending in infectious generations,the course from the appearance of pulmonary lesions to their resolution shortened (P<0.05). No differences were found in the maximal involved pulmonary fields,duration from initial fever to appearance of pulmonary lesions and course from the initial pulmonary lesions to their peak among the above three generations (P>0.05). (4) No statistical differences were found in ways of oxygen therapy and classes of antibiotics prescribed (P>0.05). With descending in infectious generation, cases treated with methylprednisolone,human γ-immunoglobulin,interferon-α,and antiviral drugs (oral ribavirin or oseltamivir) increased(P<0.05)and the duration of their use also increased(P<0.05). Conclusions With descending in infectious generations,the clinical features of SARS may become ameliorated.