摘要
目的探讨重症严重急性呼吸综合征(SARS)的临床特征及影响死亡的危险因素。方法对54例重症SARS患者临床资料进行回顾性分析,对年龄、基础疾病、并发症、实验室检查结果等因素与死亡的关系进行相关性分析。结果54例患者均有发热,其中963%为持续高热;全部有明显呼吸困难。796%患者外周血白细胞正常或降低,淋巴细胞低于020(占50%);981%的患者嗜酸粒细胞显著降低;血小板降低者占204%。35例患者外周血CD+4淋巴细胞降低至400/μL以下。血清ALT、AST、LDH及CK升高者分别为648%、630%、574%和481%,有肾功能损害者占129%。48例患者双肺受累,833%(10/12)的病例死亡前胸片可见双肺广泛的磨玻璃样改变。经综合治疗,778%的患者临床治愈出院;死亡12例,病死率为222%。出院后随访4周,333%有不同程度的肺纤维化。非条件logistic回归分析显示,年龄、基础疾病、并发症、血小板减少、CD+4降低、BUN升高与死亡显著相关(P值均<001)。结论重症SARS患者多表现为持续高热,呼吸困难,嗜酸粒细胞、淋巴细胞及CD+4显著降低,胸部X线片主要表现为大片状密度增高影、大范围肺实变及磨玻璃样改变等。高龄、合并严重基础疾病、继发感染、血小板下降、CD+4降低、BUN升高是影响死亡的主要危险因素。
Objective To investigate the clinical features and prognostic factors of patients with severe severe acute respiratory syndrome (SARS).Methods The clinical data of 54 cases of severe SARS were analyzed retrospectively.Correlation analysis was employed to determine the relationship among the factors including age,underlying diseases,complications,counts of platelets CD+_4 T lymphocytes and mortality.Results All the 54 cases had fever,52 cases (96.3%) had persistent high fever (T>39 ℃).All the cases had dyspnea.43(79.6%)cases had normal or low blood leucocyte counts and 27 cases(50%) had blood lymphocytes percentage below 20%.Blood eosinophil counts decreased significantly in 53 cases (98.1%).Platelets decreased in 20.4% (11/54) patients.35 cases (64.8%) had peripheral blood CD+_4 lymphocytes less than 400/l.Elevations of serum ALT,AST,LDH and CK were found in 64.8%,63.0%,57.4% and 48.1% of patients,respectively.12.9% cases had kidney function impairment.48 cases(88.9%)had both lungs involvement.83.3% of the dead cases (10/12) had extensive gross glass-like manifestation in both lungs on chest radiograph before death.77.8% of cases recovered after the comprehensive treatment.The mortality was 22.2%.Within 24-week follow-up,4 cases (33.3%) developed pulmonary fibrosis to some extent.Multiple regression analysis showed that age,underlying diseases,complications,decrease of serum platelets,CD+_4 lymphocytes and elevation of serum BUN were positively associated with mortality.Conclusions Severe cases of SARS tend to have higher fever,dyspnea,significantly decreased counts of eosinophils,total lymphocytes and peripheral blood CD+_4 lymphocyt.Predominant changes on X-ray include large high-densed shadow,extensive consolidation and gross glass like changes.Severe cases have a high mortality.Older age,existence of serious underlying disease and secondary infection,decrease of platelets and CD+_4 lymphocytes and elevation of serum BUN are negative prognostic factors.
出处
《中国呼吸与危重监护杂志》
CAS
2005年第1期18-22,i001,共6页
Chinese Journal of Respiratory and Critical Care Medicine
基金
广东省重大科技攻关项目(2003z02301)
广州市重大科技攻关项目(2003Z1E0011)资助
