SARS与社区获得性肺炎的对比研究

Comparison of severe acute respiratory syndrome with communityacquired pneumonia

目的 :研究严重急性呼吸综合征 (SARS)与社区获得性肺炎 (CAP)的不同特点。方法 :比较 2 0 0 3年 4月 5— 2 0日 4 5例住院 SARS患者和 2 0 0 2年 10月 1日— 2 0 0 3年 4月 1日 80例急诊 CAP患者的临床症状、血象、放射学表现、转归等方面的特点 ,总结 SARS的发病特点及病情发展规律。结果 :1SARS患者出现 38.5℃以上的发热、干咳、胸闷、憋气、头痛、肌痛、腹泻症状的比例显著高于 CAP患者 (P<0 .0 1) ;2 SARS患者白细胞降低的比例显著高于 CAP患者 (P<0 .0 1) ,白细胞升高的比例显著低于 CAP患者 (P<0 .0 1) ;3SARS组只有 2 2 .2 %的患者起病后 2 4 h内出现 X线胸片异常 ,71.1%的患者间隔 4 8h胸片有进展 ;CAP组患者在首诊时全部有 X线胸片异常 ,未见胸片进展病例 ,两者比较有显著差异 (P<0 .0 1) ;4 SARS患者对治疗反应差 ,CAP患者经治疗 3d明显好转 ,两者有显著差异 (P<0 .0 1) ;5 SARS患者重症肺炎率及病死率显著高于 CAP患者 (P均 <0 .0 1)。结论 :SARS与 CAP在临床表现、血象、放射学表现、对治疗的反应和转归等方面均有不同特点 ,应注意鉴别 ,争取作到及早诊断、及早隔离 ,避免疫情播散。

Objective: To study the features of severe acute respiratory syndrome (SARS) and community acquired pneumonia(CAP). Methods: The clinical presentation, chest radiographs, white blood cell count and outcome of 45 SARS patients from April 5 to 20 2003 were compared, with those of 80 CAP patients from October 1 2002 to April 1 2003 in our hospital, and the clinical features of SARS were summarized. Results: ①Fever above 38 5 ℃, dry cough, short of breath, headache, myalgia, diarrhea in SARS were more common in SARS patients than those in CAP( P <0 01). ②Leucopenia was more common and leukocytosis was less common in SARS than those in CAP( P <0 01). ③ 22 2 percent of SARS patients were found abnormal chest radiographs within 24 hours after onset, 71 1 percent of SARS patients were showed progressive pulmonary infiltration via serial chest radiographs, while all CAP patients had abnormal chest radiographs when they were seen first time, and no patient showed progressive pulmonary infiltration, the difference was significant between the two groups( P <0 01). ④ Patients with SARS were lack of a response to the initial antimicrobial therapy, all patients with CAP had an adequate clinical response within three days, the difference was significant between the two groups( P <0 01). ⑤ The ratio of severe pneumonia and mortality in SARS was much higher than in CAP (both P <0 01). Conclusion: The clinical presentation, chest radiographs, white blood cell count, response to initial antimicrobial therapy, and outcome in SARS is much different from CAP, differentiate them will be helpful to early recognition, prompt isolation, and prevention of its spread.