SARS患者心脏、肾脏等肺外器官损害及其临床意义——附330例临床分析  

Damage to non-pulmonary organs like heart and kidney in SARS patients:An analysis of 330 cases

作　　者：荣义辉[1] 常伟华[1] 刘艳平 马雪梅[1] 常彬霞[1] 杨永平[1] 邹正升[1] 周先志[1] 胡良平[2] 陈菊梅[1] 

机构地区：[1]解放军第302医院,北京100039 [2]军事医学科学院情报研究所,北京100071

出　　处：《第二军医大学学报》2003年第8期813-816,共4页Academic Journal of Second Military Medical University

基　　金："十五"863计划重大项目 ( 2 0 0 3 AA2 0 810 6)

摘　　要：目的 :分析严重急性呼吸综合征 (SARS)患者心脏、肾脏等肺外器官的损害及外周血象变化特点 ,并探讨其临床意义。方法 :回顾性总结 330例临床确诊的 SARS患者心脏、肾脏损害及外周血象变化特点 ,采用 SPSS11.0及 SDAS软件进行统计分析。 结果 :(1) SARS轻型患者心脏损害多在 1周内出现 ,L DH、HBDH、CK、CK- MB复常率分别为 74 .2 %、80 .6 %、10 0 %和 10 0 % ;重型患者心脏受损常出现在 1周后 ,上述心肌酶复常率分别为 32 .2 %、2 9.5 %、5 5 .2 %和 4 4 .4 % ,均显著低于轻型患者 ,其中 10例 CK- MB未恢复者全部死亡。 (2 ) 5 4 .2 %的患者平均在发病 1周 (1～ 10 d)内出现尿红细胞 ,轻型患者平均在 12 .5 (4～ 2 1) d时完全恢复正常 ,重型有 18.4 %不能完全恢复 ,两者差异显著 (P<0 .0 0 1) ;35 .75 %的 SARS患者平均在14 (5～ 2 9) d时出现肾功能改变 ,其中尿素异常者占 80 .5 % ,轻型患者全部恢复 ,重型仅 79.2 %的患者恢复 ,11例未恢复者中7例死亡。 (3) 76 .7%的患者平均在 4 (1～ 7) d内出现淋巴细胞数下降 ,平均为 (0 .83± 0 .2 5 )× 10 9/ L[(0 .13～ 1.2 6 )× 10 9/L ) ];血小板减少多发生在重型患者 (4 0 .0 % ) ,常在 2周后出现 ,仅 4 3.9%的患者可恢复。结论 :SARS患者肺外器官损害特?Objective:To analyze the features and clinical significance of damages to non pulmonary organs like the heart,kidney and peripheral blood in SARS patients.Methods:SPSS 11.0 and SDAS software packages were used to retrospectively analyze the damages to the heart,kidney and peripheral blood in 330 clinically confirmed SARS cases.Results:(1)The heart damage occurred within 1 week after SARS onset in mild cases; the rates of LDH,HBDH,CK and CK MB returning to normal were 74.2%,80.6%,100% and 100%,respectively.In severe cases,the heart damage usually occurred 1 week after SARS onset; the rates of LDH,HBDH,CK and CK MB returning to normal were 32.2%,29.5%,55.2% and 44.4%,respectively.Ten patients whose CK MB didnot return to normal died.(2) The changes of RBC count appeared after an average of 1 week (1 10 d) in 54.2% of the patients.It returned to normal in all the mild SARS cases after an average of 12.5(4 21) d but didnot in 18.4% of the severe cases ( P <0.001).The renal function changed after an average of 14(5 29) d in 35.75% of the patients and 80.5% of which had abnormal urea level.The renal function returned to normal in all the mild cases and in only 79.2% of the severe cases.Of the 11 patients without renal function recovery,7 died.(3)The decrease in lymphocyte [(0.83± 0.25)×10 9/L, ranging (0.13 1.26)×10 9/L] appeared after an average of 4(1 7) d in 76.7% of the patients.The decrease of platelet count mainly occurred in severe cases (40.0%) and usually appeared 2 weeks after SARS onset; it returned to normal level in only 43.9% of the patients.Conclusion:The non pulmonary organ damages in SARS patients are characterized by co existence of primary and secondary damages.The heart damages usually occur at the advanced stage due to direct toxic effects of SARS virus and hypoxemia.Renal damage mainly appears at the stage of viremia,and it mainly manifests as azotemian in severe cases.The changes of lymphocyte count can reflect the severity of SARS.The decrease of platelet count is seconda

关 键 词：严重急性呼吸综合征 心脏 肾脏 肺外器官损害 临床意义 外周血象 诊断 治疗 

分 类 号：R563.1[医药卫生—呼吸系统]