严重急性呼吸综合征(非典型肺炎)的胸片研究

Study of Severe Acute Respiratory Syndrome (SARS) on Chest Radiographs

目的 分析严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)患者治疗前后的X线表现 ,探讨胸片在SARS诊断与治疗中的临床价值。方法 61例SARS患者在治疗前与治疗后的不同时间作了胸部X线平片检查。男 2 3例 ,女 3 8例 ,年龄 17～ 63岁 ,平均 3 3岁。观察一系列X线平片表现。结果 61例均见肺纹理增粗 ,2 3例并网格状改变 ,肺内见薄雾状 ( 10例 )、云絮状 ( 3 3例 )、浓烟状 ( 11例 )或磨玻璃样 ( 2 3例 )阴影。首诊时肺内阴影在单侧单叶 2 9例 ,单侧多叶 9例 ,双侧 2 3例。 3 8例阴影出现在单侧者 ,2 8例在右侧 ( 74% )。肺内阴影共累及 12 9个肺叶 ,下肺叶 71个 ( 5 5 % )。患者还合并膈胸膜增厚 ( 6例 )、纵隔气肿 ( 3例 )、心影增大 ( 1例 )。 18例胸片随访见肺部阴影增多 ,其中 13例阴影由单侧向双侧发展。激素治疗可使肺部阴影在 4～ 3 7天后吸收。结论 SARS的胸片表现多种多样 ,无特异性。但胸片检查是SARS诊断、疗效观察及指导治疗的必需手段。

Objective To present the findings of patients with SARS on chest radiographs during the course of disease, and to investigate the clinical value of chest radiograph in diagnosis of SARS and in evaluation of SARS response to treatment. Methods Chest radiographs were performed in 61 patients with SARS (23 male, 38 female, 17-63 ages, average 33 years) before, during and after treatment. The changes of chest were observed on radiographs. Results The initial radiographic changes were increase in interstitial markings (61 cases), reticular interstitial pattern (23 cases), ground glass opacification (23 cases) and airspace infiltrates which was demonstrated as light fog opacities (10 cases), or shaggy cloudy shadow (33 cases), or dense fog opacities (11 cases). Opacities were in one lobe (29 cases), or multilobe of unilateral lung (9 cases) or in bilateral lung (23 cases). Of these 38 patients with unilateral involvement, 28 had right lateral involvement (74%). 129 lobes were involved, and 71 lobes were lower lobes (55%). Thickness of diaphragm pleura (6 cases), pneumomediastenum (3 cases) and large heart (1 case) were observed. Serial chest radiographs showed progression of pulmonary infiltration in 18 patients. Among them, pulmonary infiltration progressed to bilateral in 13 cases. All patients appeared to response to corticosteroid therapy, and pulmonary opacification disappeared after 4-37 days. Conclusion Various radiographic changes can be showed in patients with SARS, and may be indistinguishable from other conditions that results in airspace disease. But chest radiograph offers an important diagnostic clue to SARS, and it is valuable in showing response to therapy and designing treatment schedules. [