45例SARS病例早期临床特点及疗效的初步分析

The clinical characteristics and outcome of 45 early stage patients with SARS

目的 :了解严重急性呼吸道综合征 (SevereAcuteRespiratorySyndrome ,SARS ,即非典型肺炎 )早期临床特点 ,探讨早期诊断和治疗的方法。方法 :对 4 5例SARS患者进行回顾性分析。结果 :95 .6 % (43/ 4 5 )的患者有SARS的接触史 ,潜伏期 2～ 2 0d ,平均 (7.3± 4 .7)d。临床表现包括有发热 (44 / 4 5 ,97.8% )、干咳 (31/ 4 5 ,6 8.9% )、乏力(2 7/ 4 5 ,6 0 % )、胸闷及气短 (2 4 / 4 5 ,5 3.3% ) ,关节疼痛、腹泻 (各 12例 ,2 6 .7% ) ,4例患者出现咯血。 15例重型患者中 12例有明显呼吸困难 ,需无创呼吸机支持。约 1/ 3的患者出现血白细胞及血小板的减少 ,可有肝功能异常(2 4例 ,5 3.3% )及心肌酶谱升高 (2 6 .6 % )。胸片出现渗出影的平均时间为 (4.2± 2 .9)d ,CT出现异常的时间早于胸片 ;胸片进展及开始好转吸收的平均时间分别为 (9.3± 4 .1)d和 (14 .5± 5 .0 )d。初始糖皮质激素治疗时间平均在病后 (4.8± 3.5 )d ,一般在 (8.4± 3.9)d时激素加至最大剂量 ,重度组和普通组激素剂量分别为每天 (6 11± 2 12 )mg和 (2 6 8± 2 0 2 )mg ,P <0 .0 0 1。抗体阳性率为 6 4 .7% (2 2 / 34) ,出现阳性最早时间为第 9d ,平均 (18.2± 6 .4 )d。结论 :临床初期以发热为主要表现 ,胸片可表现为小片渗出影 。

Objective: To investigate the clinical characteristics and therapeutic effect in the early stage of patients with Severe Acute Respiratory Syndrome (SARS). Methods:A total of 45 clinical diagnosed SARS patients were enrolled in the study. Results: 43 (95.6%) of all 45 patients had exposure to SARS patients and the average incubation time was (7.3±4.7) days ( range 2 to 20 days). The clinical features including fatigue (60%), dry cough (68.9%) , dyspnea (53.3%), joint pain (26.7%) and diarrhea (26.7%). The laboratory test show that 33% patients with leukopenia and thrombocytopenia, 53.3% with elevated serum aminotransferase and 26.6% with increased creatinine kinase levels. The occurrence of abnormal chest radiographs was (4.2±2.9) days from the onset, and CT scanning was better than X ray in the early diagnosis. The average time for the progression and improvement of the chest radiographs were (9.3±4.1) and (14.5±5.0) days, respectively. The administration of corticosteroids was started (4.8±3.5) days from the onset and the maximal dosage using of steroids was (8.4±3.9) days. There was a significant difference in the dosage of steroid between severe and mild patients [(610.6±212.4)mg/day vs (268.1±202.5) mg/day, P <0.001)]. The IgG antibody was detected in 22 out of 34 (64.7%) patients and the average time for the occurrence of antibody was (18.2±6.4) days (range 9-27 days) . Conclusion: Exposure to the SARS patients happened in most patients. The most common clinical features were fever and fatigue. The most common laboratory abnormalities were leukopenia and thrombocytopenia. Serum antibody was not detected until on the 9th day of the course of illness; CT is a more sensitive method for detection of the abnormal chest radiographs than regular X ray test. The early usage of cortiscosteroids was an efficient method for the treatment , and the dosage of steroids should be individualized.