Kwan Bonnie Ching-Ha, Leung Chi-Bon, Szeto Cheuk-Chun, Wong Vincent Wai-Sun, Cheng Yuk-Lun, Yu Alex Wai-Yin, Li Philip Kam-Tao
Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong SAR.
J Am Soc Nephrol. 2004 Jul;15(7):1883-8. doi: 10.1097/01.asn.0000131522.16404.1f.
Reviewed are the clinical features and outcome of 12 chronic dialysis patients (six men) who contracted severe acute respiratory syndrome (SARS) compared with 23 sex- and age-matched nonuremic SARS patients as controls. Eight were on peritoneal dialysis (PD) and four on hemodialysis. Mean age was 58 +/- 12 yr for the dialysis patients, and 57 +/- 12 yr for the controls. The presenting symptoms of dialysis patients were similar to the controls. With appropriate protection measures, hemodialysis was performed in a dedicated area of the SARS isolation ward, while PD was continued as intermittent PD. In all seven patients with PD effluent tested, SARS-related coronavirus (CoV) could not be identified by polymerase chain reaction (PCR) or viral culture. Three dialysis patients had persistent positive stool PCR after 5 wk, whereas all nondialysis patients had negative stool PCR after 1 wk. Despite dosage adjustment, ribavirin-induced hemolytic anemia was more severe in the dialysis patients. Dialysis patients required longer hospitalization than the controls, but the mortality was similar. With appropriate protective measures, dialysis could be safely performed. Dialysis patients with SARS often require prolonged hospitalization. Furthermore, these patients may have an extended period of viral shedding, which should be carefully monitored for the purpose of infection control.
回顾了12例感染严重急性呼吸综合征（SARS）的慢性透析患者（6名男性）的临床特征和转归，并与23名性别和年龄匹配的非尿毒症SARS患者作为对照。8例接受腹膜透析（PD），4例接受血液透析。透析患者的平均年龄为58±12岁，对照组为57±12岁。透析患者的首发症状与对照组相似。采取适当的防护措施后，在SARS隔离病房的专门区域进行血液透析，而腹膜透析则以间歇性腹膜透析的方式继续进行。在所有7例检测了腹膜透析流出液的患者中，通过聚合酶链反应（PCR）或病毒培养均未检测到SARS相关冠状病毒（CoV）。3例透析患者在5周后粪便PCR持续呈阳性，而所有非透析患者在1周后粪便PCR均为阴性。尽管调整了剂量，但利巴韦林引起的溶血性贫血在透析患者中更为严重。透析患者的住院时间比对照组更长，但死亡率相似。采取适当的防护措施后，透析可以安全进行。感染SARS的透析患者通常需要延长住院时间。此外，这些患者可能有较长时间的病毒排泄期，为控制感染应仔细监测。
