严重急性呼吸道综合征X线表现及临床意义  

Chest radiographic appearances of SARS patients and their clinical significance

作　　者：张伟[1] 杨永平[1] 邹正升[1] 王华明[1] 辛绍杰[1] 周先志[1] 常彬霞[1] 常伟华[1] 刘艳平 马雪梅[1] 李保森[1] 赵军[1] 游绍利[1] 荣义辉[1] 陈菊梅[1] 胡良平[1] 

机构地区：[1]解放军第302医院感染二科,北京100039

出　　处：《第三军医大学学报》2003年第20期1850-1852,共3页Journal of Third Military Medical University

基　　金："8 6 3"计划科技攻关基金资助项目 ( 2 0 0 3AA2 0 810 6 )~~

摘　　要：目的　分析严重急性呼吸道综合征 (Severacuterespiratorysyndrome ,SARS)患者X线表现和变化规律。方法　使用SPASS11.0及SDAS软件回顾性分析 3 3 0例临床确诊的SARS患者 ,对病后的一系列X线胸片和高清晰度CT(HRCT)影像进行分析。结果　① 2 1.5 %的患者入院时X线胸片检查无明确炎性改变 ,90 %SARS患者在 1周内X线胸片出现局造性斑片状模糊影 ,2周内达高峰 ,肺部存在阴影者仅 98 8%,另有 1.2 %的患者始终没有X线胸片改变 ,但CT有改变 ,80 %的患者在 5周内康复。②急性期胸部X线绝大多数以肺实质性病变为主 ,形态多样 ,双肺同时受累率高 (初期47%,最重时 5 9 5 %)为其特点。③轻型SARS以一个肺叶病变为主 ( 5 3 %) ,多为周边型 ( 5 3 1%) ,吸收好 ,恢复快 ;重型SARS多以二个或二个以上肺叶病变为主 ( 70 3 %) ,多为中央或混合型 ( 71 8%) ,其中混合型占 5 0 %,间质性损害为主 ,吸收慢预后差。④ 45例恢复期患者的HRCT检查 ,71.2 %留有肺间质改变。结论　SARS患者早期可出现多种X线胸片炎性改变 ,双肺同时受累率高 ,尤以中央型或混合型重症比例高 ,发展快 ,预后差 ;Objective To study the chest radiographic appearances and dynamic changes in patients with severe acute respiratory syndrome(SARS) by high resolution computerized tomography(HRCT) and the related clinical significance. Methods A series of chest radiographs of 330 SARS patients confirmed clinically were analyzed retrospectively using SPASS 11.0 and SDAS softwares. Results No obvious inflammatory changes on chest radiographs were found in 21.5% patients at admission. However, in the first week, the main abnormality of 90% SARS patients was single or bilateral localized patchy clouding opacity on chest radiographs, and the area of opacity peaked within 2 weeks. No abnormal appearance on chest radiographs was found in only 1.2% patients in the course of disease. At the acute stage, the main abnormality on chest radiograph appearances was the opacity of lung, various shapes, involving large area of the lungs at high rate(47% at the early stage and 59.5% at the acute stage). In mild SARS patients, one lobe of the lungs(53%) was involved, and pathological changes were mainly located in the edges(53.1%), but disappeared rapidly and recovered well. However, in severe SARS patients, two lobes or more of the lungs (70.3%) were involved, and pathological changes were mainly central type(21.8%) or mixed type(50%), but the absorption was slow and prognosis was poor. HRCT performed in 45 SARS patients in the recovery phase showed lung interstitial abnormality in 71.2% patients. Conclusion Various kinds of inflammatory changes, particularly the central type or mixed type, involving most area of the lungs, can be found on chest radiographs of SARS patients at the early stage. The central type or mixed type develops rapidly and the prognosis is poor. Therefore, early HRCT is suggested for patients suspicious of SARS.

关 键 词：严重急性呼吸道综合征 放射摄影术 高清晰度 CT扫描 

分 类 号：R563.8[医药卫生—呼吸系统] R814.4[医药卫生—内科学]