SARS康复期患者半年血清抗体、肺功能和影像学资料分析

Content of serum SARS-CoV IgG antibody, lung function and lung radiographic changes in SARS patients six months after convalescence

目的 了解SARS康复者SARS冠状病毒特异性IgG抗体、肺功能和肺部影像学的变化。方法 2 93例北京地区SARS患者康复后半年内定期进行SARS冠状病毒特异性IgG抗体、肺功能和胸部影像学检查 ,合并有肺弥散功能异常的康复者定期进行肺功能和胸部影像学复查 ,动态观察肺功能的恢复情况。部分合并有骨关节疼痛的患者进行股骨头磁共振检查。结果 2 93例中有 2 33例SARS冠状病毒特异性IgG抗体阳性 (79 5 % ) ,且半年内抗体水平有逐渐下降趋势。特异性IgG抗体阳性的康复者中 5 6例合并有肺部影像学异常 ,5 7例 (2 4 5 % )合并有弥散功能(DLCO)异常 ,其中 4 0例半年内进行了 3次以上肺功能检查 ,发现其肺功能和肺部影像学变化均有不同程度的改善。 6 0例进行股骨头磁共振检查的康复者中有 1 5例发现有股骨头缺血性坏死改变 (2 5 % )。结论 临床诊断为SARS的患者中可能有部分为误诊病例 ,SARS康复者合并的肺纤维化改变在一定时期内可明显吸收和好转 ,部分康复者合并有股骨头缺血性坏死改变。

Objective To study the changes in serum SARS coronavirus (SARS CoV) IgG antibody, and lung function and radiographic image of the lung six months after being discharged from the hospital. The incidence of femoral head necrosis in some of them was also evaluated. Methods 293 patients who were convalescent from SARS regularly received SARS CoV IgG antibody assay, lung function test and chest X ray and/or high resolution computerized tomography (HRCT) examination in the General Hospital of PLA 6 months after being discharge. In the patients who were found to have lung diffusion abnormity (D L CO<80% pred), regular lung function test and HRCT examination were done in the follow up phase in order to observe their pulmonary fibrotic changes. In patients who complained of joint pain MRI examination of the hip joint was done. Results 79 5% of patients (233 of 293 patients) were positive for SARS CoV IgG test. There were 24 5% of patients (57 out of 233) were found to be suffering from lung diffusion abnormity (D L CO<80%pred), and 24 0% (56 out of 233 patients) were found to have lung fibrotic changes in 233 patients who were positive for SARS CoV IgG test. During the six months, lung function and radiographic changes were shown to be improved in 40 patients with diffusion abnormality who received serial follow up examinations. In 25% of patients (15 out of 60 patients) who received magnetic resonance imaging (MRI) examination of the hip joint were found to have necrosis of the femoral head. Conclusion The results suggested that there might be misdiagnosis in the SARS patients, and the fibrotic changes in the lung could be improved by itself. In some patients femoral head necrosis occurred.