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目的:分析2004年在北京发生的严重急性呼吸综合征(SARS)早期胸部影像特点及相对应的临床表现,并对比2003年资料,探讨其早期的表现,为临床提供借鉴。方法:对2004年在北京地坛医院住院的7例SARS患者的临床、化验、胸片及高分辨CT(HRCT)资料进行回顾性分析。结果:6例均急性起病,体温>38℃,无上呼吸道卡他症状,发热第1周出现肺部局灶或多段分布的阴影,阴影常呈类圆型,多表现为磨玻璃影,其内可见小叶间隔增厚,部分表现肺实变影,病灶内可见支气管气像,无坏死或空洞病灶,无肺门及纵隔淋巴结肿大,无胸腔积液。发热的第2周,肺部阴影迅速扩大,或发展至对侧,出现呼吸困难,在出现肺部阴影进展时,给予糖皮质激素,阴影在2~3d内明显吸收,临床症状改善。病程早期,白细胞不增高,淋巴细胞和血小板偏低,血乳酸脱氢酶(LDH)在第2周明显增高,丙氨酸氨基转移酶(ALT)和天冬氨酸氨基转移酶(AST)在第2或第3周开始增高。结论:对于急性起病、发热、白细胞不高、胸部HRCT表现类圆型磨玻璃阴影伴小叶间隔增厚或肺实变、短期抗生素治疗无效的患者应提高警惕,注意排除SARS。
Objective: To analyze the characteristics and clinical manifestations of early chest imaging of SARS in Beijing in 2004, and to compare the data of 2003 with the data of early stage to explore its clinical manifestations. Methods: The clinical, laboratory, radiographic and high resolution CT (HRCT) data of 7 SARS patients hospitalized in Beijing Ditan Hospital in 2004 were analyzed retrospectively. Results: 6 cases were acute onset, body temperature> 38 ℃, no upper respiratory tract catarrhal symptoms, the first week of fever appeared focal lung or multi-segment distribution, the shadow often showed round, more performance of ground glass, The interlobular septa can be seen thickening, some manifestations of lung consolidation, bronchial airway lesions can be seen, no necrosis or empty lesions, no hilar and mediastinal lymph nodes, no pleural effusion. The first 2 weeks of fever, the rapid expansion of the shadow of the lungs, or the development of the contralateral, breathing difficulties appear in the progress of lung shadow, given glucocorticoid, the shadow of significant absorption within 2 ~ 3d, clinical symptoms improved. In the early course of the disease, leukocytes were not increased, lymphocytes and platelets were low, LDH was significantly increased in the second week, and alanine aminotransferase (ALT) and aspartate aminotransferase Week 2 or 3 began to increase. CONCLUSIONS: Patients with acute onset, fever, and low white blood cells, with round-robin shadows in chest radiographs with thickening of the interlobular septa or lung consolidation, and ineffective short-term antibiotic therapy should be warned to exclude SARS.