Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis
Haematological manifestations in patients with severe acute respiratory syndrome: retrospective analysis
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DOI：
10.1136/bmj.326.7403.1358
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发表时间：
2003-06-21
影响因子：
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通讯作者：
Sung, JJY
中科院分区：
文献类型：
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作者：
Wong, RSM;Wu, A;Sung, JJY
目的探讨严重急性呼吸综合征（SARS）患者的血液学特征。设计分析SARS患者的人口学、临床和实验室特征。受试者2003年3月11日至3月29日期间确诊为SARS的所有患者，现有的血液系统疾病。主要结果测量临床终点包括需要重症监护和死亡。结果本研究共纳入64例男性和93例女性患者。最常见的结果包括157例患者中的153例（98%）淋巴细胞减少症，129例（82%）嗜中性粒细胞减少症，87例患者（55%）血小板减少症，其次是77例（49%）血小板增多症，96例患者（63%）孤立性活化部分凝血活酶时间延长。95例（61%）患者的血红蛋白计数较基线下降超过20 g/l。4例患者（2.5%）发生弥散性血管内凝血。尸检时血液淋巴器官中显示淋巴细胞减少症。多变量分析显示高龄和高浓度乳酸脱氢酶是不良预后的独立预测因素。分析了31例患者外周血淋巴细胞亚群。CD 4+和CD 8 + T细胞计数在病程早期下降。CD 4和CD 8细胞计数低与不良结局有关。结论SARS患者血液学指标异常是常见的。淋巴细胞减少症和T淋巴细胞亚群耗竭可能与疾病活动性相关。
Objectives To evaluate the haematological findings of patients with severe acute respiratory syndrome (SARS).Design Analysis of the demographic, clinical, and laboratory characteristics of patients with SARS.Setting Prince of Wales Hospital, Hong Kong.Subjects All patients with a diagnosis of SARS between 11 March and 29 March 2003 who had no pre-existing haematological disorders.Main outcome measures Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed to examine factors associated with adverse outcome.Results 64 male and 93 female patients were included in this study. The most common findings included lymphopenia in 153 (98%) of the 157 patients, neutrophilia in 129 (82% thrombocytopenia in 87 patients (55%), followed by thrombocytosis in 77 (49%), and isolated prolonged activated partial thromboplastin time in 96 patients (63%). The haemoglobin count dropped by more than 20 g/l from baseline in 95 (61%) patients. Four patients (2.5%) developed disseminated intravascular coagulation. Lymphopenia was shown in haemato-lymphoid organs at postmortem examination. Multivariate analysis showed that advanced age and a high concentration of lactate dehydrogenase at presentation were independent predictors of an adverse outcome. Subsets of peripheral blood lymphocytes were analysed in 31 patients. The counts of CD4 positive and CD8 positive T cells fell early in the course of illness. Low counts of CD4 and CD8 cells at presentation were associated with adverse outcomes.Conclusions Abnormal haematological variables were common among patients with SARS. Lymphopenia and the depletion of T lymphocyte subsets may be associated with disease activity.