128例SARS病例的临床特点

Clinical Characteristics of 128 SARS Cases

目的探讨SARS的临床特征。方法对广州市某SARS定点医院128例SARS住院病例的性别、年龄分布、接触史、症状、体征、实验室检查、影像学特点、并发症、治疗与预后等进行系统分析。结果本组患者平均年龄37.6±14.5岁,男性54例,女性74例,69例(53.9%)有SARS病人接触史,3例有明确的野生动物接触史;入院前平均病程为5.79±5.56d;入院时主要症状为发热(123例,96.1%)、咳嗽(74例,57.8%)、全身酸痛(26例,20.3%)、呼吸困难(12例,9.4%)和腹泻(10例,7.8%)等;实验室检查见白细胞计数低下(35例,27.3%)、肝功能ALT异常升高(35例,27.3%)、心肌酶CK异常升高(26例,20.3%)和肾功能Cr异常升高(3例,2.3%)。胸片显示89.1%(114例)的病例在入院时可发现肺部病灶,X线主要表现为渗出性病变,显示为淡薄云雾状或片状的浸润阴影,平均累积肺叶数为2.12±1.27;31.3%(40例)出现并发症;经过系统治疗,63.3%(81例)的病例在住院后10d内病灶已开始吸收。平均住院天数为20.73±11.68d。119例(93%)康复出院,9例死亡,病死率7%;22.7%(29例)出院时胸片仍显示存在纤维化病灶。结论SARS的临床特点主要表现为发热、咳嗽、全身酸痛、白细胞计数偏低、易累及心、肝、肾等脏器,胸片主要为片絮状阴影,经治疗多数病例预后良好,但要注意肺部的残留纤维化。

Objective To investigate the clinical characteristics of patients with SARS(severe acute respiratory syndrome) . Methods Systematic analysis of the demographic features, contacts, symptoms, physical examinations, laboratory tests, chest radiographs, complications, treatments and prognoses of 128 SARS patients in a hospital of Guangzhou city. Results The average age of 128 (54 males and 74 females) SARS patients was 37.6±14.5 years. 69 of 128 (53.9%) cases had close contact with SARS patients or suspected SARS patients. 3 persons had clear contact with wild animals. The length before admission to hospital after the onset of the disease was 5.79±5.56 days. The most common symptoms of the SARS patients were fever (123 cases, 96.1%), cough (74 cases, 57.8%), myalgia (26 cases, 20.3%), shortness of breath (12 cases, 9.4%) and diarrhea (10 cases, 7.8%). The patients were diagnosed with leukopenia (35 cases, 27.3%), elevated ALT levels (35 cases, 27.3%), elevated creatine kinase levels (26 cases, 203%), and elevated Cr levels (3 cases, 2.3%). In chest radiographs, 97.7% (125 of 128 cases) developed air space patch shadowing opacities and an average of 2.12±1.27 lung lobes were infiltrated. 31.3% (40 of 128 cases) were with complications. After systematic treatments, the air space opacities in 63.3% (81 of 128 cases) patients were decreased in the first 10 days of treatment. The mean length of hospitalization was 20.73±11.68 days. 119 of 128 (93%) patients were cured and 9 died. The fatality rate was 7%. But 22.7% (29 cases) remained with lung fibrosis at the time of discharged from the hospital. Conclusions The main clinical characteristics of SARS were fever, cough, myalgia, leukopenia and chest patch opacities. The function of liver and heart were easily impaired. Most patients were with well prognoses, but some with lung fibrosis.