SARS诊治新进展

Recent progress in the management of SARS in China

520 0 2年 11月到 2 0 0 4年 5月间 ,中国大陆总共发生了三次 SARS事件。第一次事件期间爆发了 SARS大流行 ,但由于制定了严密的政策和管理措施 ,第二次、第三次 SARS事件并没有演化成疫情。对 SARS病毒基因组的研究发现 ORF8出现的基因缺失与疫情中晚期病毒毒性增加和传染强度改变有关 (The Chinese SARSMolecules Epidemiology Consortium:Science2 0 0 4 )。在一般情况下 ,SARS是通过近距离飞沫传染 ,而某些特殊条件下 ,可通过空气传染 ,香港陶大花园疫情为一例 (YuTSet al;NEJM2 0 0 4 )。一些食肉目猫科动物 ,尤其是果子狸 ,是 2 0 0 2、2 0 0 3年 SARS传播的重要传染源 (Guan Yet al:Science2 0 0 3)。这些可疑动物进入野味市场 ,成为 SARS的传播源头 ,对预防工作带来极大困难。 2 0 0 4年初 ,广东省政府和卫生厅采取了强有力的行动 ,清理野味市场 ,提出“四早”,防止出现 SARS人传人病例。这个决策卓有成效 ,防止了第二次 SARS疫情的爆发。有证据表明 ,说明 SARS患者“亚临床”感染不少见。针对 SARS病毒 N蛋白的抗原检测 ,可在发病 7天之内确诊 SARS。广州市的对照研究表明 ,重症 SARS患者或合并 ARDS者使用激素可减少病死率 ,缩短住院天数。目前正在进行全 SARS病毒灭活疫苗的临床试验 。

There were three events of SARS in the mainland of China from November 2002 to May 2004.Although a SARS pandemic broke out during the first event,it was circumvented during the latter two,due to establishment of strict policies and control measures.A study of molecular evolution of SARS-CoV during SARS-pandemic in the mainland showed that deletion of nucleotides in orf8 was closely associated with the infectivity and toxicity of SARS-CoV.Generally speaking,SARS-CoV was transmitted via droplets over a short distance.Under certain circumstance,as in the Amoy Garden,virus can spread via air-borne transmission.Some wildlife from Felidae Carnivora(flesh-eating animal of the cat family),like civet cats,were suspected as important reservoir in SARS-CoV transmission to human beings (Guan Y et al:Science 2003).By entering exotic food markets,these suspects have become the topmost link by far recognized in SARS transmission route as dangerous sources undermining the preventing of SARS.Early in the year of 2004,the Guangdong local government and Department of Public Health tokk strong actions regarding strict control of the wildlife market and `four earliness' to stop transmission from human to human.This control strategy seems to have effectively prevented the second SARS event from evolving into an outbreak.Studies have shown evidences of sub-clinical patients of SARS.Antigen detection targeting at N-protein of SARS-CoV has also shown benefit in confirming diagnosis within 7 days after onset.From a controlled study in Guangzhou,administreation of corticosteroids was associated with reduced mortality and shorter hospital stay in SARS patients with acute lung injury of ARDS.Clinical trials using inactivated whole SARS-CoV vaccine is currently in process.Results will be available at the beginning of next year.Researches on genotherapy using small interfering RNA(SiRNA) have also been initiated for the prevention and treatment of SARS-CoV infection.