典型家庭聚集性严重急性呼吸综合征17例流行病学及临床特点分析

Epidemiologic and clinical features of 17 typical family-clustered SARS cases

目的探讨典型家庭聚集性严重急性呼吸综合征(SARS)流行病学及临床特点.方法对1例SARS患者以及受其感染的16位家人的流行病学和临床资料进行回顾性调查分析.结果受到感染发病的16例患者与首发病者有明显的密切接触史,呈典型家庭聚集现象.传播途径为多方面的,以近距离空气飞沫传播和密切接触为主,其他可能存在的传播途径为消化道.潜伏期为2～9 d,平均(4.9±2.2)d;以发热为首发症状(100%),持续时间(10.5±4.6)d;伴有干咳(76.5%),气促、呼吸困难(76.5%)、腹泻(23.5%);白细胞正常或降低占88.2%,血清丙氨酸转氨酶升高58.8%,乳酸脱氢酶/肌酸激酶升高41.2%,外周血CD3、CD4、CD8明显降低;X线胸片都有明显肺部病变,累及双肺占75%,以渗出性炎症改变为主.结论SARS的流行病学特征为近距离接触传染性强;临床特点以发热、干咳、气促、肺部X线胸片表现以渗出性实变为主.发病机制可能与细胞免疫受损有关.采取有效消毒隔离措施,加强个人防护,切断传播途径等,可使该病传播得到有效控制.

ObjectiveTo investigate the epidemiologic and clinical features of typical cases of family-clustered serious acute respiratory syndrome(SARS).MethodsThe epidemiologic and clinical data of one SARS patient and 16 family members infected by the index case were analyzed retrospectively.ResultsThere was a clear history of close contact between the first case and the other 16 cases,demonstrating apparent family-clustered phenomenon.There were multiple routes for SARS transmission.Airborn droplet within short distance and intimate contact were the major transmission route.Transmission through gastrointestinal tract may also be possible.Incubation period ranged from 2 to 9(average 4.9±2.2) days.Fever was the initial symptom (100%) with an average duration of 10.5±4.6 days.Accompanying symptoms included:cough ( 76.5%),breathlessness ( 76.5%),and diarrhea(23.5%).Laboratory tests revealed normal or decreased WBC count in 88.2% cases,elevated ALT level in 58.8% cases,elevated LDH/CPK level in 41.2% cases and CD3,CD4,CD8 significantly decreased in peripheral blood.Chest X-ray showed remarkable changes,with involvement of both lobes in 75% cases,mainly with exudative inflammation.ConclusionsThe epidemiology of SARS was showed strong infections characteristic of close contact.The characteristic clinical manifestations,include fever,cough,breathlessness and exudative infiltration in chest X-ray film.The pathogenesis of the disease may related to the impairment of cellular immune function.Effective control measures including isolation of patients,strengthen personal protection measures,block the transmission routes etc..