18例儿童严重急性呼吸综合征临床分析

Clinical analysis of pediatric SARS cases in Beijing

目的 分析儿童严重急性呼吸综合征 (SARS)的临床特征。方法 北京儿童医院和地坛医院儿科病房 2 0 0 3年 4月 8日～ 5月 12日收入院的 18例有流行病学史的疑似SARS患儿 ,总结其流行病学史、临床表现和有关资料。结果 (1)流行病学史 :18例中 14例与SARS有近距离密切接触 ,4例小区有SARS患者。从密切接触到发病潜伏期 3～ 14d。 (2 )临床表现 :除 1例外均有发热和咳嗽 ,高热为主 ,1例低热。仅 2例有呼吸急促。腹泻 2例 ,头痛和乏力各 3例。 (3)胸X线片 :13例有浸润性阴影 ,9例住院后有加重趋势 ,但很快吸收好转。 (4)血清学检测 :检测的 15例中SARS病毒IgG阳性 8例 ,IgM阳性 6例。其中 4例有密切接触史而无胸X线片改变者中 3例检测了SARS病毒抗体均阴性。 (5 )治疗 :主要为对症、用抗病毒药治疗 ,多数患儿使用了丙种球蛋白 ,部分患儿使用了皮质激素治疗 ,仅 2例吸氧 ,无一例人工通气 ,无一例死亡。住院后病情迅速控制。结论 儿童SARS有其自身临床特点 ,症状、体征较成人表现为轻。 4例有密切接触史而无明显胸X线片改变的病例 ,有待可靠病原学检查证实和进一步研究。

Objective To study clinical characteristics of pediatric SARS cases in Beijing. Methods Eighteen pediatric cases with SARS diagnosed on admission were analyzed. The cases were admitted to Beijing Children′s Hospital and Ditan Hospital (pediatric ward) from April 8 to May 12. Results The 18 children aged 5 months to 15 years (10 male and 8 female) had epidemiologically linked findings. Fourteen cases had close contact with SARS patients. Four cases were living in the community where adult SARS patients were found. All the 18 patients but one presented with fever and cough. Most of them had high fever, 2 cases had bradycardia, 2 had diarrhea, and another 2 had tachypnea. Malaise and headache were noted only in 3 cases respectively which were much less frequently seen than in adult patients. Symptoms and signs of the children were much less severe and aggressive than adults cases. Thirteen children had chest radiographic consolidation. Of them, 9 cases had progressive changes after admission, then improved quickly. We did not find significant lower hemoglobin and platelet levels. Most patients had leukopenia and lymphopenea. Serologic test was performed for 15 cases and 8 were positive for SARS virus-IgG and 6 for IgM antibody. Of the 4 cases who had close contact with SARS adults and without chest radiograph abnormal findings, 3 were negative for SARS virus-antibodies. Part of the patients had temporary abnormality of myocardial enzyme and liver function. All these children finally had rapid improvement on chest radiograph. The patients were treated with antiviral agents and corticosteroid. Only two cases required oxygen therapy. No child needed assisted ventilation and no death, nor lung fibrosis occurred. After hospitalization, all patients were improved and discharged when this paper was being written. The average hospital stay of these patients was 14.6 days (6-22 days). Conclusion Compared with adults, pediatric SARS patients seemed to have their own clinical characteristics. The disease in children had lower severity and infectivity than that in adults. The machnisms of the disease in children should be studied in well-designed clinical trials. Cases like the 4 children who had close contact with SARS adult patients but without chest radiographic changes deserve further studies with the help of more reliable and sensitive etiologic tests.