广州地区医务人员严重急性呼吸综合征的临床特点

Clinical feature and immunological analysis of a cluster of medical workers with severe acute respiratory syndrome in Guangzhou

目的 探讨医务人员感染严重急性呼吸综合征 (SARS)的流行病学、临床表现、实验室及放射学检查、血清免疫学和恢复期的情况。方法 对我院 2 2例患SARS医务人员的临床资料及SARS血清免疫学 (IgM、IgG)抗体变化规律进行了回顾性的分析。 结果 年龄 2 3～ 53岁 ,平均 ( 3 2 .5± 7.0 )岁。潜伏期为 2～ 7d ,平均 ( 4 .1± 1.5)d。传播途径以呼吸道飞沫和近距离密切接触导致传播。最常见的临床表现是发热 ( 10 0 % )、畏寒 ( 68.2 % )、继之发生干咳 ( 72 .7% )和气促 ( 63 .6% )以及与之相关联的X线胸片浸润表现 ( 77.3 % )、外周血白细胞正常或减少 ( 90 .9% )、淋巴细胞减少 ( 4 5.5% )、血清丙氨酸转氨酶升高 ( 54.5% )。通过检测患者血清新型冠状病毒IgM和IgG抗体发现 ,发病两周时 ,两种抗体均已产生。 3个月后 ,IgM消失 ,而IgG仍维持在高水平。结论 SARS有高度传染性。发热和随之而来的呼吸道综合征是主要症状和体征 ,血清中检出IgM抗体 ,可认为近期感染 ;血清中检出IgG抗体 ,则表明曾感染过 。

Objective To discuss epidemiological, clinical and laboratory characteristics,chest radiography, serum immunology and conditions in convalescence in patients with severe acute respiratory syndrome(SARS). Methods We retrospectively analyzed clinical data of 22 medical workers with SARS and observed the change of Immunoglobulin M and Immunoglobulin G in their serial sera immunology. Results The patients ranged from 23 to 53 years old (mean age 32.5±7.0). The incubation period ranged from 2 to 7 days(mean period 4.1±1.49 ). Infectious patterns suggested through air droplet or close contact transmission. The most common symptoms included fever(100%), chilly(68.2%), followed by nonproductive cough (72.7%) and dyspnea (63.6%) associated with infiltrates on chest radiography (77.3%). Normal in white blood count or Leukopenia (90.9%) , Lymphopenia (45.5%) and elevated alanine aminotransferase levels (54.5%) were common. By testing the serum IgM and IgG antibody of patients, we found a positive result in 2 weeks after the onset of SARS. Though IgM antibody show negative 3 months later, IgG antibody remained a high level. Conclusions SARS appears to be highly infectious.Fever and subsequent respiratory syndrome is the most common symptom and sign. Our research has disclosed that a positive serum IgM antibody means a infection in the near future, while a positive serum IgG antibody indicates a infection of past and probably with immunity.