影响SARS临床病程的多因素分析

Multivariable Analysis of Factors Affecting Clinical Course in Patients with SARS

【目的】对可能影响严重急性呼吸综合征(SARS)临床病程的多种因素进行Logistic回归分析,初步评价何种因素对SARS病程有影响。【方法】入选的SARS病例共85例(医务人员占92.9%),男15例,女70例,平均年龄(28.9±9.8)岁。以反映临床病程的指标作为因变量,包括持续发热时间,肺部病变初始出现至发展到最高峰的时间,肺部病变吸收时间。以可能影响临床病程的指标作为协变量,包括年龄、性别、潜伏期、初始体温、最高体温、持续发热≥39℃时间、病程中最大受累肺野数目、外周血白细胞减少、抗生素、甲基泼尼松龙、丙种球蛋白、干扰素α、其他抗病毒药物等。应用二项分类Logistic回归对多因素进行分析。【结果】①影响持续发热的危险因素是病程中最大受累肺野数目、性别和最高体温;②影响肺部病变发展至高峰的危险因素是病程中最大受累肺野数目;③影响肺部病变吸收时间的因素是病程中最大受累肺野数目、干扰素α和年龄,其中受累肺野数目和年龄是危险因素。【结论】病程中最大受累肺野数是影响SARS临床病程的重要危险因素,年龄大、男性以及高体温等危险因素在不同方面影响SARS临床病程,干扰素α可能有助于缩短肺部病变吸收时间。

To study factors affecting clinical course of severe acute respiratory syndrome(SARS) with logistic regression for multivariable analysis to evaluate which factors effect on clinical course. 85 cases of SARS were selected and 92.9%of them were medical staff . Among these patients, 15 were male and 70 female with mean age of (28.9 ±9.8) years. Factors reflecting clinical course were set as the dependent,including duration of fever,the interval between initial pulmonary radiographic lesions to climax and the interval between initial pulmonary radiographic lesions to recovery, while those affecting clinical course as the covariates,including age, sex, incubation time, initial temperature, peak temperature, duration of persistent fever ≥39 ℃, maximum number of involved pulmonary filed, leucopenia, antibiotics, methylprednisolone, immunoglobulin G, interferon αand other antiviral drugs. For the above factors, binary logistic regression was performed. Risk factors affecting duration of fever were the maximum number of involved pulmonary filed, sex, and peak temperature. Risk factor affecting pulmonary lesions progressing to the climax is the maximum number of involved pulmonary filed. Factors affecting the interval between initial pulmonary radiographic lesions to recovery were maximum number of involved pulmonary filed, interferon-αand age,among which the maximum number of involved pulmonary field and age were risk factor. [Conclusion]The maximum number of involved pulmonary filed is the important risk factor affecting clinical course of SARS,and meanwhile such factors as advanced age, male, and peak temperature affect the clinical course in respective way. Interferon-αmay contribute to shorten duration from initial pulmonary changes to recovery.