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医院获得性严重急性呼吸综合征的长期骨骼和肺部后果:一项前瞻性队列研究的15年随访

Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study.

作者信息

Zhang Peixun, Li Jia, Liu Huixin, Han Na, Ju Jiabao, Kou Yuhui, Chen Lei, Jiang Mengxi, Pan Feng, Zheng Yali, Gao Zhancheng, Jiang Baoguo

机构信息

1Department of Orthopedics and Trauma, Peking University People's Hospital, Beijing, China.

2Department of Respiratory Medicine, Peking University People's Hospital, Beijing, China.

出版信息

Bone Res. 2020 Feb 14;8:8. doi: 10.1038/s41413-020-0084-5. eCollection 2020.

Abstract

The most severe sequelae after rehabilitation from SARS are femoral head necrosis and pulmonary fibrosis. We performed a 15-year follow-up on the lung and bone conditions of SARS patients. We evaluated the recovery from lung damage and femoral head necrosis in an observational cohort study of SARS patients using pulmonary CT scans, hip joint MRI examinations, pulmonary function tests and hip joint function questionnaires. Eighty medical staff contracted SARS in 2003. Two patients died of SARS, and 78 were enrolled in this study from August 2003 to March 2018. Seventy-one patients completed the 15-year follow-up. The percentage of pulmonary lesions on CT scans diminished from 2003 (9.40 ± 7.83)% to 2004 (3.20 ± 4.78)% ( < 0.001) and remained stable thereafter until 2018 (4.60 ± 6.37)%. Between 2006 and 2018, the proportion of patients with interstitial changes who had improved pulmonary function was lower than that of patients without lesions, as demonstrated by the one-second ratio (FEV/FVC%,  = 2.21,  = 0.04) and mid-flow of maximum expiration (FEF,  = 2.76,  = 0.01). The volume of femoral head necrosis decreased significantly from 2003 (38.83 ± 21.01)% to 2005 (30.38 ± 20.23)% ( = 0.000 2), then declined slowly from 2005 to 2013 (28.99 ± 20.59)% and plateaued until 2018 (25.52 ± 15.51)%. Pulmonary interstitial damage and functional decline caused by SARS mostly recovered, with a greater extent of recovery within 2 years after rehabilitation. Femoral head necrosis induced by large doses of steroid pulse therapy in SARS patients was not progressive and was partially reversible.

摘要

非典康复后最严重的后遗症是股骨头坏死和肺纤维化。我们对非典患者的肺部和骨骼状况进行了15年的随访。在一项对非典患者的观察性队列研究中,我们使用肺部CT扫描、髋关节MRI检查、肺功能测试和髋关节功能问卷评估了肺部损伤和股骨头坏死的恢复情况。2003年,80名医务人员感染了非典。两名患者死于非典,78名患者于2003年8月至2018年3月纳入本研究。71名患者完成了15年的随访。CT扫描显示肺部病变的百分比从2003年的(9.40±7.83)%降至2004年的(3.20±4.78)%(<0.001),此后一直保持稳定,直到2018年为(4.60±6.37)%。2006年至2018年期间,肺功能有所改善的间质性改变患者的比例低于无病变患者,一秒率(FEV/FVC%,=2.21,=0.04)和最大呼气中期流量(FEF,=2.76,=0.01)表明了这一点。股骨头坏死的体积从2003年的(38.83±21.01)%显著下降至2005年的(30.38±20.23)%(=0.000 2),然后从2005年至2013年缓慢下降至(28.99±20.59)%,并在2018年保持稳定(25.52±15.51)%。非典导致的肺间质损伤和功能下降大多得到恢复,康复后2年内恢复程度更大。非典患者大剂量激素脉冲治疗引起的股骨头坏死没有进展,且部分可逆。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/b19a/7018717/bbb9963394d7/41413_2020_84_Fig1_HTML.jpg

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