Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study
Long-term bone and lung consequences associated with hospital-acquired severe acute respiratory syndrome: a 15-year follow-up from a prospective cohort study
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DOI：
10.1038/s41413-020-0084-5
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发表时间：
2020-02-14
期刊：
影响因子：
12.7
通讯作者：
Jiang, Baoguo
中科院分区：
文献类型：
--
作者：
Zhang, Peixun;Li, Jia;Jiang, Baoguo
SARS康复后最严重的后遗症是股骨头坏死和肺纤维化。我们对SARS患者的肺部和骨骼状况进行了15年的随访。我们在一项观察性队列研究中对SARS患者进行了肺CT扫描、髋关节MRI检查、肺功能检查和髋关节功能问卷调查，以评估肺损伤和股骨头坏死的恢复情况。二零零三年，有80名医护人员感染沙士。2例患者死于SARS，2003年8月至2018年3月期间入组了78例患者。71例患者完成了15年随访。CT扫描显示的肺部病变百分比从2003年的（9.40 +/- 7.83）%降至2004年的（3.20 +/- 4.78）%（P < 0.001），此后保持稳定，直到2018年（4.60 +/- 6.37）%。2006年至2018年，间质性病变患者肺功能改善的比例低于无病变患者，表现为一秒比值（FEV 1/FVC%，t = 2.21，P = 0.04）和最大呼气中段流速（FEF25%-75%，t = 2.76，P = 0.01）。股骨头坏死体积较2003年明显减少（38.83 +/- 21.01）%至2005年（30.38 +/- 20.23）%（P = 0.000 2），然后从2005年到2013年缓慢下降（28.99 +/- 20.59）%，直到2018年达到稳定（25.52 +/- 15.51）%。SARS引起的肺间质损害和功能下降大部分恢复，康复后2年内恢复程度较大。大剂量激素冲击治疗引起的股骨头坏死在SARS患者中不是进行性的，并且是部分可逆的。
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)% (P < 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 (FEV1/FVC%, t = 2.21, P = 0.04) and mid-flow of maximum expiration (FEF25%-75%, t = 2.76, P = 0.01). The volume of femoral head necrosis decreased significantly from 2003 (38.83 +/- 21.01)% to 2005 (30.38 +/- 20.23)% (P = 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.