广东省严重急性呼吸综合征临床诊断标准回顾分析

Retrospective discriminant analysis on the clinical diagnostic criteria for severe acute respiratory syndrome in Guangdong province

目的选择广东省的严重急性呼吸综合征(SARS)临床资料数据库,应用判别分析法对当时的诊断标准进行回顾分析,评价新增的病原学指标的诊断敏感性。方法完善广东省的SARS临床资料数据库后,分两组:①按临床确诊标准选取SARS患者402例;②从广州医学院第一附属医院和广州市第八人民医院选取同期住院、经专家组讨论排除SARS的疑似患者176例。应用判别分析法自动筛选出区分两组患者的关键指标。结果判别结果为:①有接触SARS病人,起病早期血清抗原或含漱液PCR(简称PCR)呈阳性,可确诊为SARS患者;②有接触SARS病人,PCR呈阴性和抗体呈阳性,可确诊为SARS患者;③有接触SARS病人,PCR呈阴性和抗体呈阴性,可确诊为非SARS患者;④没有接触SARS病人,抗体呈阳性,可确诊为SARS患者;⑤没有接触SARS病人,抗体呈阴性,可确诊为非SARS患者。结论上述得出的判别规则是对卫生部临床诊断标准的补充,增加病原学指标能提高诊断的快速性和准确性。

Objective To evaluate the diagnostic sensitivity of new pathogenic parameters for severe acute respiratory syndrome （SARS） in Guangdong province by discriminant analysis retrospectively of SARS database 2003. Methods The subjects in modified SARS database of Guangdong province were divided into two groups. One group of 402 SARS patients were selected according to the diagnostic criteria for SARS of the Ministry of Health. The other group included 176 subjects who were excluded from SARS by the expert panel from the First Affiliated Hospital of Guangzhou medical college and the 8th Municipal Hospital of Guangzhou. The clinical differences between the two groups and the key index for the diagnosis of SARS were screened by discriminant analysis. Results SARS diagnosis were confirmed by the followings：A. Having a definite exposure with SARS patients and PCR positive result for SARS. B. Having a definite exposure with SARS patients, PCR negative but serological positive result for SARS. C. Having a definite exposure with SARS patients, both serological and PCR negative result could exclude SARS. D. No exposure history with SARS patients and serologically positive result for SARS. E. SARS were excluded if the serologically negative and without exposure history with SARS patients. Conclusions Our differential criteria for SARS is supplementary to the diagnostic criteria by the Ministry of Health. Incorporation of virus detection can improve the accuracy and efficacy of SARS diagnosis.