SARS: prognosis, outcome and sequelae
SARS: prognosis, outcome and sequelae
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DOI：
10.1046/j.1440-1843.2003.00522.x
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发表时间：
2003-11-01
期刊：
影响因子：
6.9
通讯作者：
Ip, MS
中科院分区：
文献类型：
--
作者：
Chan, KS;Zheng, JP;Ip, MS
严重急性呼吸综合征（SARS）在急性期具有相当高的发病率和死亡率。在受影响最严重的地区，全球病死率为11%（范围为7%至27%）。已经确定了几个不良预后因素，包括高龄，合并症的存在，较高的乳糖脱氢酶水平和初始中性粒细胞计数，但病毒和其他宿主因素对结果的影响尚不清楚。有关SARS后遗症的已发表数据有限。对SARS康复者的临床随访显示，他们的放射学、功能和心理均有不同程度的异常。在早期康复阶段，许多人抱怨身体功能受到全身无力和/或呼吸急促的限制。在接受胸部CT扫描的一小部分受试者中，超过一半的受试者显示出与肺纤维化一致的斑片状变化。出院后6 - 8周的肺功能检查显示，6 - 20%的受试者出现轻度或中度限制性模式，与肌无力一致。在少数受试者中检测到一氧化碳弥散量轻度降低。初步证据表明，这些肺功能异常将随着时间的推移而改善。焦虑和/或抑郁的心理行为问题在早期恢复阶段并不少见，并且在大多数患者中随时间推移而改善。据报道，髋关节缺血性坏死是另一种并发症。SARS的长期后遗症在很大程度上仍然是未知的。重要的是要对这些患者进行随访，以检测和适当管理身体，心理和社会领域的任何持续或新出现的长期后遗症。
Severe acute respiratory syndrome (SARS) is associated with considerable morbidity and mortality in the acute phase. Worldwide case fatality rate is 11% (range 7 to 27%) for the most severely affected regions. Several adverse prognostic factors have been identified, including advanced age, presence of comorbidity, higher lactose dehydrogenase levels and initial neutrophil count, but the impact of viral and other host factors on outcome is unknown. Published data on sequelae of SARS are limited. Clinical follow-up of patients who recovered from SARS has demonstrated radiological, functional and psychological abnormalities of varying degrees. In the early rehabilitation phase, many complained of limitations in physical function from general weakness and/or shortness of breath. In a small series of subjects who underwent CT scan of the chest, over half showed some patchy changes consistent with pulmonary fibrosis. Lung function testing at 6-8 weeks after hospital discharge showed mild or moderate restrictive pattern consistent with muscle weakness in 6-20% of subjects. Mild decrease in carbon monoxide diffusing capacity was detected in a minority of subjects. Preliminary evidence suggests that these lung function abnormalities will improve over time. Psychobehavioural problems of anxiety and/or depression were not uncommon in the early recovery phase, and improved over time in the majority of patients. Avascular necrosis of the hip has been reported as another complication. The long-term sequelae of SARS are still largely unknown. It is important to follow up these patients to detect and appropriately manage any persistent or emerging long-term sequelae in the physical, psychological and social domains.