Chiang Chi-Huei, Shih Jen-Fu, Su Wei-Juin, Perng Reury-Perng
Chest Department, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan.
Mayo Clin Proc. 2004 Nov;79(11):1372-9. doi: 10.4065/79.11.1372.
To define the clinical characteristics and clinical course of hospital-acquired severe acute respiratory syndrome (SARS).
This 8-month prospective study of 14 patients with hospital-acquired SARS in Taipei, Taiwan, was conducted from April through December 2003.
The most common presenting symptoms in our 14 patients with hospital-acquired SARS were fever, dyspnea, dizziness, malaise, diarrhea, dry cough, muscle pain, and chills. Lymphopenia and elevated serum levels of lactate dehydrogenase (LDH) and C-reactive protein (CRP) were the most common Initial laboratory findings. Initial chest radiographs revealed various pattern abnormalities and normal results. Five of the 14 patients required mechanical ventilation. The need for mechanical ventilation was associated with bilateral lung involvement on the initial chest radiograph and higher peak levels of LDH and CRP. Clinical severity of disease varied from mild to severe. At 8 months after disease onset, patients with mild or moderate SARS had normal findings or only focal fibrosis on chest high-resolution computed tomography. However, bilateral fibrotic changes remained in the 4 patients who had recovered from severe SARS, 1 of whom had mild restrictive ventilatory impairment. One patient with severe SARS died; she was elderly and had other comorbidities. Five additional patients had reduced diffusing capacity.
The clinical picture of our patients presenting with hospital-acquired SARS revealed atypical pneumonia associated with lymphopenia, elevated serum levels of LDH, rapid clinical deterioration, and lack of response to empirical antibiotic therapy. Substantially elevated levels of LDH and CRP correlated with severe illness requiring mechanical ventilatory support. In those receiving mechanical ventilation, pulmonary function was only mildly reduced at 6 to 8 months after acute illness, consistent with the natural history of acute respiratory distress syndrome due to other causes.
明确医院获得性严重急性呼吸综合征（SARS）的临床特征及临床病程。
本前瞻性研究于2003年4月至12月在台湾台北对14例医院获得性SARS患者进行了为期8个月的观察。
14例医院获得性SARS患者最常见的首发症状为发热、呼吸困难、头晕、乏力、腹泻、干咳、肌肉疼痛和寒战。淋巴细胞减少以及血清乳酸脱氢酶（LDH）和C反应蛋白（CRP）水平升高是最常见的初始实验室检查结果。初始胸部X线片显示有各种形态异常及正常结果。14例患者中有5例需要机械通气。需要机械通气与初始胸部X线片显示双侧肺部受累以及LDH和CRP的峰值水平较高有关。疾病的临床严重程度从轻度到重度不等。发病8个月后，轻度或中度SARS患者的胸部高分辨率计算机断层扫描结果正常或仅有局灶性纤维化。然而，4例从重症SARS康复的患者仍有双侧纤维化改变，其中1例有轻度限制性通气功能障碍。1例重症SARS患者死亡；她为老年患者且有其他合并症。另有5例患者的弥散功能降低。
我们的医院获得性SARS患者的临床表现显示为非典型肺炎，伴有淋巴细胞减少、血清LDH水平升高、临床快速恶化以及对经验性抗生素治疗无反应。LDH和CRP水平显著升高与需要机械通气支持的重症疾病相关。在接受机械通气的患者中，急性疾病后6至8个月肺功能仅轻度降低，这与其他原因导致的急性呼吸窘迫综合征的自然病程一致。
