90例SARS患者含漱液内冠状病毒定量与临床转归的相关研究

Clinical study of 90 patients’SARS-Co-V RNA quantity in gargle

目的通过对SARS患者含漱液内冠状病毒定量与临床转归的相关性的初步研究,以期能建立起客观的SARS重症救治早期预警指标.方法对2003年4～5月在本院诊断的90例SARS成年患者,77例SARS密切接触者进行含漱液的实时荧光定量(RT-PCR)方法检测SARS病毒定量,将其结果与临床转归进行对比分析.结果77例SARS密切接触者含漱液中病毒检测均为阴性,90例SARS病人病程第5～11天含漱液内病毒检测48例为阳性,且21例病毒定量>1.0×102copies/ml者中的9人出现ARDS,6人死亡,与病毒定量阴性或病毒定量<1.0×102copies/ml者比较仅各1例发展至ARDS,1例死亡,具有显著性差异.结论含漱液用于检测SARS病毒核酸对于早期诊断和未发病者的监测有着重要的意义.含漱液内SARS病毒定量高者有可能成为'超级传播者'.SARS患者的含漱液内冠状病毒定量愈高提示疾病愈可能是重型,应加强监护,及早治疗,以期提高治愈率,降低病死率,是客观的SARS重症救治早期预警指标,应引起重视.

Objective To study the relationship between the SARS-Co-V RNA and the clinical manifestation in order to find a fore alert of severe SARS for prognosis so that strong and effective treatment can be administered as soon as possible to increase cure rate and low mortality. Method 90 patients with SARS were group A, and 77 health care staff was group B. All the patients were admitted in Beijing Ditan Hospital from April 2003 to May 2003. 77 health care staff all had close contact with the SARS patients. Quantitative revers-transcriptase （RT） PCR of gargle was detected in the two groups. We compared and analyzed the results of the two groups. Result RT-PCR of gargle was tested at day 5 - 11 after onset of symptoms in the SARS patients. 21 of them had higher copies more than 1.0×10^2copies/ml. 9 of the 21 patients progressed into ARDS and 6 patients died. The patients with low RNA copies （ 〈 1.0 ×10^2copies/ml or negative） had better prognosis. RT-PCR of blood and gargle in the care worker group was all negative. There was marked difference between the two groups. Conclusion RT-PCR of the gargle is useful to confirm SARS . The patients with high RTPCR of the gargle may become a “super-spreader”， Higher RT-PCR of the gargle often suggest severe condition. Intensive care and better treatment are needed to increase cure rate and descend mortality.