北京首批重症急性呼吸综合征患者临床特征及预后分析  

Analysis of severe acute respiratory syndrome in Beijing

作　　者：姜天俊[1] 周先志[1] 赵敏[1] 周志平[1] 姜素椿[1] 叶文华[1] 李永刚[1] 赵景民[2] 毛远丽[3] 马威[4] 曲芬[3] 王冶[1] 赫兢[1] 聂为民[1] 张云晖[1] 谢杨新[1] 闫慧颖[1] 

机构地区：[1]解放军第302医院感染一科,北京100039 [2]解放军第302医院病理科,北京100039 [3]解放军第302医院检验科,北京100039 [4]解放军第302医院放射科,北京100039

出　　处：《中华内科杂志》2003年第6期369-372,共4页Chinese Journal of Internal Medicine

摘　　要：目的　探讨重症急性呼吸综合征 (SARS)临床特征 ,分析其预后影响因素。方法　以北京地区首批 34例SARS患者为研究对象 ,观察其临床特征及辅助检查 ,并对 1例死亡患者尸检。结果　患者年龄平均 (33 4± 13 4 )岁 ;潜伏期 2～ 14d ,中位数 4d。发热 (10 0 % )、心悸 (91 7% )、肌痛(79 2 % )、头痛 (70 8% )、腹泻 (73 9% )、咳嗽 (5 8 3% )为主要临床表现。初诊时白细胞计数平均 (4 6± 1 4 )× 10 9/L ,淋巴细胞平均 0 2 7± 0 11,淋巴细胞绝对计数 (1 2 3± 0 4 6 )× 10 9/L ,6 8 4 %病例低于正常。ALT、乳酸脱氢酶、血沉水平升高者分别占 76 2 %、2 8 6 %、4 7 8% ,血清铁、血清白蛋白水平降低者分别为 6 3 2 %、38 1%。 32例有胸部X线检查异常 ,2例CT扫描发现异常。尸检 :肺脏和淋巴组织受累明显。多因素分析显示 ,不良预后独立影响因素是高龄。结论　发热、淋巴细胞和血清铁降低及胸部影像学检查可早期诊断SARS ;年龄为该病预后的独立预测因素。Objective To study the clinical, laboratory, and radiologic features of 34 cases of severe acute respiratory syndrome (SARS) in Beijing. Methods All patients were admitted to the isolation wards . Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Univariate and multivariate analyses were performed. Results Eight patients came from a family, and 15 patients were medical staff. The mean age of patients was (33.4± 13.4)years. The latent period varied from 2 to 14 days(median 4 days). The most common symptoms were fever (100%), palpitation(91.7%), myalgia (79.2%), headache(70.8%), diarrhea(73.9%)and cough(58.3%). The mean leucocyte count was(4.6±1.4)×10 9/L, and the mean lymphocyte ratio was 0.27±0.11. 68.4 % of the patients had lymphopenia(absolute lymphocyte count <1.3×10 9/L). Other common findings included elevated levels of serum alanine aminotransferase, lactate dehydrogenase and erythrocyte sedimentation (76.2%, 28.6% and 47.8%, respectively),and decreased levels of serum iron and albumin(63.2% and 47.8%,respectively). Thirty-two cases had abnormal chest radiographs. In 2 cases in whom typical lung opacities could not be found on the initial plain chest radiographs, thoracic CT proved to be useful. Postmortem examination of 1 patient revealed marked edema with foci of hemorrhage and hyaline membrane formation in the lungs, hemorrhage necrosis and a obvious decline of cells in lymph glands. In a multivariate analysis(Stata 7.0), the independent predictor of an adverse outcome was advanced age (odds ratio per decade of life, 1.6; 95% CI ,1.08 to 2.63; P =0.007).Conclusions Fever, lymphopenia, low serum iron and chest radiograph are helpful to diagnose SARS early;age is the independent predictor of an outcome.

关 键 词：北京 重症急性呼吸综合征 SARS 治疗方法 诊断 预后 

分 类 号：R511.9[医药卫生—内科学]