五例严重急性呼吸综合征患儿的临床和胸部X线表现特点  

Clinical and chest X-ray characteristics of 5 cases with severe acute respiratory syndrome in children in Shenzhen area

作　　者：陆普选[1] 周伯平[2] 胡毅文[2] 杨桂林[2] 杨大国[2] 骆子义[2] 陈心春[3] 龚小龙[1] 杨根东[1] 王召钦[2] 袁本通[4] 

机构地区：[1]深圳市东湖医院放射科,518020 [2]深圳市东湖医院传染科,518020 [3]深圳市东湖医院分子生物学实验室,518020 [4]深圳市第二人民医院呼吸科

出　　处：《中华儿科杂志》2003年第9期645-647,U002,共4页Chinese Journal of Pediatrics

摘　　要：目的　探讨儿童SARS的临床和胸部X线表现特点。方法　分析 5例经流行病学、临床、实验室和放射学检查确诊的SARS患儿临床资料和胸部X线表现。结果　 5例SARS患儿中 ,3例有明确的SARS密切接触史。发热为首发症状 ,4例体温在 3 8℃以上 ,最高 40℃ ,持续时间 4～ 7d ,平均 5.6d。实验室检查 :SARS病毒RNA特异性片段RT PCR检测阳性 1例 ;SARS病毒抗体IgM和IgG双项阳性 1例 ,SARS病毒抗体IgG单项阳性 2例 ,IgM单项阳性 1例。肺炎支原体 ,肺炎衣原体IgG、IgM及血培养等均阴性。胸部X线表现 :单侧肺部片状影或斑片状阴影 4例 ,其中磨玻璃样阴影及游走性改变者 1例 ;肺内间质性改变者 1例 ,表现为不规则网格状及索条状影 ;肺部病灶吸收时间最短 7d ,最长 3 3d ,平均 ( 15± 6)d ,无 1例出现肺部纤维化改变。 5例全部治愈出院。结论　儿童SARS与成人相比 ,其临床症状和体征相对比较轻。胸部X线表现以肺的单侧片状阴影改变为主 。Objective To explore clinical and chest X ray features of SARS in children to facilitate correct diagnosis. Methods Clinical manifestations and chest X ray findings in five children suffering from SARS admitted for treatment in the hospital between February and May, 2003 in Shenzhen area were analyzed. The diagnosis was confirmed by epidemiological, clinical, laboratory and radiological examinations. Among the 5 cases, 1 was a boy and the others were girls at the age of 4 to 13 years. Results Of the 5 SARS children, 3 presented a history of close contact with SARS patients. Fever was the initiative symptom, 4 had a body temperature of over 38℃ with the highest being 40℃; fever sustained from 4 to 7 days with an average of 5.6 days. All the 5 cases developed nonproductive cough; on auscultation, both moist and dry rales could be heard in 3 out of the 5 cases. Mean total white count of peripheral blood was (2 96-6.9)×10 9/L,and was <5.0×10 9/L in 4 cases. SARS associated coronavirus specific RNA fragment was found positive by RT PCR in 1 case; 1 case was positive for both IgM and IgG antibodies to the virus; 1 case was positive for only IgM antibody and another 2 cases were positive for only IgG antibody. IgG and IgM antibodies to Mycoplasma pneumoniae and Chlamydia pneumoniae as well as blood culture for bacteria were all negative. Findings on chest X ray examination: 4 cases showed presence of patchy or macular opacities with cord like shadows in unilateral lung plates while 1 case each showed ground glass like opacity and migratory changes; 1 case showed interstitial changes in the lungs in the form of irregular reticular lattice and cord like shadows. Two cases received CT scanning and macular patchy or spotty shadows were seen all over the lung. The shortest time for absorption of foci in the lungs was 7 days while the longest was 33 days with a mean of 15±6 days. None of the cases had any signs of fibrosis in the lungs. All the 5 cases were completely cured and discharged 7 to 40 days

关 键 词：严重急性呼吸综合征 SARS 传染性非典型肺炎 小儿 胸部X线检查 流行病学 

分 类 号：R725.1[医药卫生—儿科]