Measurement of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome and its clinical significance

Objective To investigate the changes of subgroups of peripheral blood T lymphocytes in patients with severe acute respiratory syndrome (SARS) and its clinical significance.Methods Subgroups of blood T lymphocytes in 93 patients with SARS were detected by flow cytometer. The results detected in 64 normal subjects and 50 patients with AIDS served as controls.Results The numbers of CD3 +, CD4 +, and CD8 + lymphocytes all significantly decreased in acute phase of patients with SARS [(722±533)/μl, (438 ±353)/μl, (307±217)/μl)] compared with those in normal controls [ (1527±470)/μl, (787±257)/μl, (633±280)/μl, all P<0. 01) ], which was different from what we observed in patients with AIDS who had decreased CD4 + [ (296±298)/μl] but increased CD8 + [ (818 ±566)/μl counts. The counts of CD3+, CD4+, and CD8 + lymphocytes decreased more apparently in patients with severe SARS. All the five patients who died had CD4 + counts less than 200/μl. As the patients' condition improved, CD3 +, CD4 +, and CD8 + counts gradually returned to normal ranges.Conclusion The damage of cellular immunity is probably an important mechanism of pathogenesis of SARS.

Clinical analysis of 45 patients with severe acute respiratory syndrome

Objective To explore the clinical and radiological features of severe acute respiratory syndrome (SARS).Methods Analysis of the clinical presentation, chest radiographs, course of disease and features of severe pneumonia in 45 SARS patients diagnosed at our hospital in Beijing between April 5 - 20, 2003. Also included is a summation of the clinical features of SARS.Results (1) SARS appears to have high infectivity; (2) the most common symptom is fever; (3) the count of leukocyte is normal or decreased; (4) most patients (35/45, 77.8%) had experienced a 24-hour fever prior to the abnormal chest X-ray changes which showed progression of pulmonary infiltrates within 48 hours in 71.1% (32/45) of the patients and, (5) the percentage of patients who developed severe pneumonia (24. 4%) is higher than those who developed typical pneumonia.Conclusion SARS is a disease with high infectivity and has its own clinical and radiological features. Early recognition, prompt isolation, and appropriate therapy are the key to combate this infection.

The chest X-ray image features of patients with severe SARS: a preliminary study

Objective To study the chest X ray image features of patients with severe SARS Methods Chest X ray image features in 36 patients with severe SARS were retrospectively analyzed The image characteristics were compared with those of 224 patients with common SARS Results The important chest X ray imaging features of 36 patients with severe SARS included small patch of infiltration (n=27, 75 0%), large patch of infiltration (n=22, 61 1%), large area of lung consolidation (n=10, 27 3%), interstitial lung lesion (n=26, 72 2%), ground glass shadow (n=28, 77 8%), irregular linear opacity (n=15, 41 7%), diffuse lung lesion (n=12, 33 3%), with single lung involved (n=9, 25 0%), and both lungs involved (n=32, 88 9%) The rates of large patch of infiltration, large area of lung consolidation, ground glass shadow, diffuse lung lesion and involvement of both lungs in patients with severe SARS were significantly higher than those in patients with common type of SARS (all P <0 01) Out of the 11 severe SARS patients who died, nine had large area of ground glass shadow with air bronchogram in both lungs before death Conclusions Large patch of infiltration, large area of consolidation, ground glass shadow, diffuse lung lesion and involvement of both lungs were the main X ray image characteristics of patients with severe SARS Large area of ground glass shadow with air bronchogram in both lungs indicated a bad prognosis

中西医结合治疗非典型肺炎103例临床观察

目的:观察中西医结合方法治疗非典型肺炎的疗效。方法:西医采用营养支持、呼吸机辅助通气、抗感染及糖皮质激素等方法治疗;中药根据中医辨证分期选方用药。统计学方法采用描述性分析法。结果:103中治愈96例(93.2%),死亡7例(6.8％);入院治疗后退热时间为(6.72±3.95)天;胸片复查病灶完全吸收94例,病灶吸收时间(18.13±8.99)天;2例胸片呈局部纤维索条样改变。结论:SARS属中医“温病”范畴,采用中西医结合治疗有积极作用。

医院内SARS暴发流行的临床分析

目的 :总结严重急性呼吸综合征 (SARS,或称传染性非典型肺炎 ,IAP)的临床表现、诊断和治疗 ,以及外界输入性病例引起暴发流行的传染链特点。方法 :对 2例外院输入病例的临床资料和传染链进行分析 ,并总结 4 1例 SARS患者的临床资料。结果 :1SARS患者的传染性极强 ,防范不当可使大量人群感染 ;2 SARS的临床特征主要是发热 (10 0 .0 % ) ,有相当部分患者在发病初期 (1～ 3d)呼吸道症状并不明显 (占 5 3.7% ) ,并伴有外周血白细胞 (5 2 .6 % )和淋巴细胞 (6 8.4 % )比例减少 ;3早期给予利巴韦林、甲基氢化泼尼松和免疫增强治疗对控制病情的进一步发展有一定效果。结论 :重视防范、早发现、早隔离和早治疗 ,对改善 SARS的预后和控制其蔓延有着十分重要的意义。

260例SARS病人胸部X线表现

目的 探讨传染性非典型肺炎的胸部X线表现。方法 回顾性分析 2 60例传染性非典型肺炎胸部X线表现。结果 2 60例传染性非典型肺炎胸部X线表现可见 :斑片状影 183例 (70 .3 8% ) ;大片状影 10 2例 (3 9.2 3 % ) ;间质改变 2 0 8例 (80 % ) ;磨玻璃样改变 113例 (4 3 .46% ) ;大范围肺实变 3 1例 (11.92 % ) ;索条状影 10 8例 (4 1.5 4% ) ;弥漫性病变 42例(16.15 % ) ;单肺受累 96例 (3 6.92 % ) ;双肺受累 176例 (67.69% )。结论 不同程度的肺组织实变是SARS的共同特征 ,胸片能够显示和诊断传染性非典型肺炎 ,应作为传染性非典型肺炎常规检查方法。

传染性非典型肺炎17例临床分析

目的 分析四川地区传染性非典型肺炎 (非典 )的流行病学和临床特点。方法 对2 0 0 3年 2月以来四川省已临床诊断的非典患者进行回顾性分析。结果 迄今四川省已临床诊断非典患者 17例 ,均为来自广东和北京疫区的输入性病例 ,发病年龄以青壮年为主 ,起病较急骤 ,88%(15 / 17)的患者体温超过 38℃ ,咳嗽较常见 ,部分有血丝痰 ,周围血白细胞计数减少或正常居多 ,X线片显示多叶多段病变特点 ,初期进展较快而后期恢复较慢。 4例作血清学试验 ,2例阳性。 1例尸检标本在电镜下检出冠状病毒颗粒和衣原体样颗粒 ,RT PCR扩增出冠状病毒RNA聚合酶基因片段。死亡 2例 ,已痊愈出院 7例。结论 四川地区非典型肺炎均为输入性病例 ,临床表现与其他地区报道相似 ,但病情相对较轻 ,传染性较弱 ,未造成继发性感染。

严重急性呼吸综合征全身多脏器超微病理学观察

目的 探讨SARS全身多脏器超微结构病变的特点及意义。方法 6例SARS尸检标本透射电镜观察。结果 肺与全身多个脏器中均可见冠状病毒样颗粒 ,并伴有不同程度的超微结构损伤。结论 冠状病毒在人体内存在多种形态 ,具有较广泛的侵袭性和强烈的嗜血管性。

严重急性呼吸综合征易发季节200例住院肺炎患儿临床分析

目的对2004年SARS易发的整个季节中,符合SARS诊断标准2+3+4条的肺炎病例的临床资料作回顾性分析,以供日后鉴别诊断参考。方法对2004年1～5月本院收治的符合《传染性非典型肺炎临床诊断标准》2+3+4条共200例肺炎患儿住院期间血、呼吸道分泌物等临床资料作回顾性分析。结果所有患儿均有发热,白细胞计数不高或降低,入院时胸片均有改变,绝大部分为斑片状渗出影;200例中51例肺炎支原体检测阳性,38例呼吸道合胞病毒(RSV)检测阳性,10例肺炎链球菌阳性,9例流感嗜血杆菌阳性,8例副流感病毒检测阳性及少数其他病原体;入院48h内124例体温降至正常。结论SARS易发季节儿童SARS需与肺炎支原体、呼吸道合胞病毒、流感病毒等病原体引起的肺炎相鉴别。

传染性非典型肺炎后股骨头坏死的病因及治疗

背景:大部分非典型肺炎患者在康复早期出现了不同程度的髋关节滑囊炎并逐步发展为股骨头坏死。目的:分析非典型肺炎后遗症股骨头坏死各种病因,并介绍股骨头坏死治疗方法。方法:由第一作者应用计算机检索PubMed、中国期刊全文数据库(CNKI)、维普数据库和万方数据库1997年1月至2012年8月相关文献。在标题、摘要、关键词中以"传染性非典型肺炎,后遗症,股骨头坏死,骨缺血,病因,传染性非典型肺炎病毒,保守治疗,手术治疗,全髋置换"或"infectious atypical pneumonia sequela,femoral head necrosis,bone ischemia,etiology,infectious atypical pneumonia virus,conservative treatment,operation treatment,total hip replacement"为检索词进行检索,初检得到872篇,最终选择56篇文献进行综述。结果与结论:传染性非典型肺炎后遗症股骨头坏死与患者在治疗过程中使用激素剂量大小、使用时间长短、患者对激素敏感程度及使用的方法及患者本身分泌的瘦素及骨降钙素量的多少有密切关系,还与传染性非典型病毒本身的作用有密切关系。由于这些病因导致股骨头坏死,先采用保守治疗减慢股骨头坏死的进程,延迟假体的置换,最终大部分患者还是采用手术治疗,传染性非典型肺炎后遗症股骨头坏死晚期置入假体置换是治疗股骨头坏死最好的结果。

SARS相关冠状病毒感染致全身多脏器损伤电镜观察

目的:探讨 SARS 肺脏及全身多脏器超微结构病变的特点及意义。方法:6例 SARS 尸检标本超薄切片,透射电子显微镜观察。结果:SARS 患者全身多个脏器中都存在着不同形态的冠状病毒样颗粒,包括肺、心、肝、肾、胃、脾、淋巴结及睾丸。而在脑、肠道、胰腺及甲状腺等器官仅在血管内皮中发现冠状病毒样颗粒。肺脏主要超微病变为肺泡Ⅰ型上皮脱落、基底膜裸露破坏,肺泡Ⅱ型上皮增生,纤维蛋白颗粒构成透明膜,毛细血管内皮肿胀及通透性增加,病程较长病例出现间质纤维化。脾脏与淋巴结中树突状细胞萎缩失活,淋巴细胞大量凋亡及溶解坏死,单核吞噬细胞系统细胞肿胀变性和机能减退。全身其它脏器的实质细胞多呈线粒体与内质网肿胀扩张及空泡变性,还可见凋亡与坏死改变。全身所有器官组织中的内皮细胞都呈高度水肿、空泡变性及连接结构破坏,而且在内皮基质中多含有大量的冠状病毒样颗粒。结论:冠状病毒在人体内具有多种形态和较广泛的侵袭性,并具有强烈的嗜血管性。血管内皮损伤是肺脏、免疫器官及全身器官病变的重要基础。

“非典间歇期”医院防治SARS工作的探讨

目的 探讨“非典间歇期”医院防治SARS工作的方法。方法 回顾防治SARS第一阶段工作完成后 ,在“非典间歇期”医院所采取的各种防治方法和措施。结果 诊治发热病人总数为 80 8人 ,其中发热门诊诊治789人 ,留观 19人 ,未发现疑似SARS病例及医学观察病例。结论 在“非典间歇期” ,医院作为防治SARS的第一哨点应重点做好以下几个方面的工作 :制定常规状态下防治SARS预案 ;加强医务人员的防治知识、防护技能的培训和演练 ;完善发热门诊、留观室三个区域和两个通道的划分 ;进一步规范发热病人的诊断、鉴别诊断、护理及治疗的工作流程 ;加强医院感染的监测和控制 ;做好疫情监测工作 ,及时发现疫情。

严重急性呼吸综合征患者血清超氧化物歧化酶含量的动态观察

目的 观察SARS患者血清超氧化物歧化酶 (SOD)含量变化。方法 用放射免疫法检测 2 9例SARS患者血清SOD含量 ,与正常对照组作了比较。结果 患者SOD含量明显低于对照组 ,重型SARS患者SOD含量明显低于普通型。恢复期不同阶段患者血清SOD含量回升但仍低于对照组。结论 SARS患者体内产生过量的自由基分子 ,使SOD过度消耗。SOD含量变化可以反映病情程度 ,检测血清SOD水平有助于病情的观察。加强机体清除自由基的能力可能是重要的治疗措施之一。

中西医结合治疗非典型肺炎近况

中西医两种医学体系在基础理论方面有很大的不同,二者应互相取长补短。非典型肺炎属中医"温病"的范畴,采用中西医结合治疗有显著的优势。中西医结合治疗的优越性在很多方面引人注目,已有的临床经验值得总结。