Clinical and laboratory features of severe acute respiratory syndrome vis-a-vis onset of fever.
Clinical and laboratory features of severe acute respiratory syndrome vis-a-vis onset of fever.
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发烧发作的严重急性呼吸综合征的临床和实验室特征。
作者：
Liu CL;Lu YT;Peng MJ;Chen PJ;Lin RL;Wu CL;Kuo HT
严重急性呼吸综合征（SARS）是一种由新型冠状病毒（CoV）感染引起的快速进展性疾病。然而，疾病的表现是非特异性的。本研究的目的是明确定义一组SARS患者的临床表现、临床进展和实验室数据。回顾性观察研究。台湾台北一家拥有51间负压隔离室的三级医疗中心。二○ ○三年四月二十七日至六月十六日期间发现五十三宗严重急性呼吸系统综合症个案。发热（即体温> 38°C）是最常见的症状（98%），也是最早出现的症状。当被送往医院隔离病房观察时，大多数患者报告了与发烧有关的非特异性症状。只有两名先前存在疾病的患者在发烧开始的同一天咳嗽。最终，39例患者（74%）在发热发作后平均（± SD）4.5 ± 1.9天开始咳嗽，35例患者（66%）在发热发作后平均6.0 ± 3.3天开始腹泻。31例患者（59%）入院时胸片异常，除1例患者（98%）外，所有患者最终均发生与肺炎一致的肺浸润。大多数患者（63%）在发热后平均4.5 ± 2.1天首次出现单灶性浸润，而37%的患者的初始浸润是多灶性的，平均在发热后5.8 ± 1.3天出现。常见的实验室检查结果包括淋巴细胞减少症（入院时，70%;住院期间，95%），血小板减少症（入院时，28%;住院期间，40%），乳酸脱氢酶升高（入院时，58%;住院期间，88%），肌酸激酶（入院时，18%;住院期间，32%）和天冬氨酸转氨酶或丙氨酸转氨酶水平（入院时，27%;住院期间，62%）。咽拭子或鼻咽拭子的SARS冠状病毒的逆转录聚合酶链反应（PCR）和实时PCR是阳性的47例患者中的40例（85%）进行测试。目前的症状或实验室检查结果都不是SARS的特征性症状。尽管大多数患者出现咳嗽，但直到病程后期才出现咳嗽，这表明在发热之前或同时出现咳嗽不太可能表明SARS。虽然PCR检测SARS冠状病毒似乎是目前最好的早期诊断测试，但很明显，需要更好的方法来区分SARS和非SARS疾病的最初表现。
Severe acute respiratory syndrome (SARS) is a rapidly progressive disease caused by a novel coronavirus (CoV) infection. However, the disease presentation is nonspecific. The aim of this study was to define clearly the presentation, clinical progression, and laboratory data in a group of patients who had SARS. Retrospective observational study. A tertiary care medical center with 51 negative-pressure isolation rooms in Taipei, Taiwan. Fifty-three patients with SARS seen between April 27 and June 16, 2003. Fever (ie, temperature > 38°C) was the most common symptom (98%) and the earliest. When admitted to the isolation unit of the hospital for observation, most patients reported nonspecific symptoms associated with their fever. Only two patients with preexisting illnesses had cough on the same day the fever began. Eventually, 39 patients (74%) developed cough, beginning at a mean (± SD) time of 4.5 ± 1.9 days after fever onset, and 35 patients (66%) had diarrhea beginning at a mean time of 6.0 ± 3.3 days after fever onset. Thirty-one patients (59%) had abnormal findings on chest radiographs on hospital admission, and all but 1 patient (98%) eventually developed lung infiltrates that were consistent with pneumonia. The majority of patients (63%) first developed unifocal infiltrates at a mean time of 4.5 ± 2.1 days after fever onset, while in 37% of patients the initial infiltrates were multifocal, appearing at a mean time of 5.8 ± 1.3 days after fever onset. Common laboratory findings included lymphopenia (on hospital admission, 70%; during hospitalization, 95%), thrombocytopenia (on hospital admission, 28%; during hospitalization, 40%), elevated lactate dehydrogenase (on hospital admission, 58%; during hospitalization, 88%), creatine kinase (on hospital admission, 18%; during hospitalization, 32%), and aspartate aminotransferase or alanine aminotransferase levels (on hospital admission, 27%; during hospitalization, 62%). Throat or nasopharyngeal swab for SARS-CoV by reverse transcriptase polymerase chain reaction (PCR) and real-time PCR was positive in 40 of the 47 patients (85%) in whom the test was performed. None of the presenting symptoms or laboratory findings are pathognomonic for SARS. Even though cough developed in a majority of patients, it did not occur until later in the disease course, suggesting that a cough preceding or concurrent with the onset of fever is less likely to indicate SARS. While PCR for SARS-CoV appears to be the best early diagnostic test currently available, it is clear that better methods are needed to differentiate between SARS and non-SARS illness on initial presentation.
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DOI：
10.1016/s0140-6736(03)13077-2
发表时间：
2003-04-19
期刊：
Lancet (London, England)
影响因子：
--
作者：
Peiris JS;Lai ST;Poon LL;Guan Y;Yam LY;Lim W;Nicholls J;Yee WK;Yan WW;Cheung MT;Cheng VC;Chan KH;Tsang DN;Yung RW;Ng TK;Yuen KY;SARS study group
通讯作者：
SARS study group
DOI：
10.1016/s0140-6736(03)13967-0
发表时间：
2003-07-26
期刊：
Lancet (London, England)
影响因子：
--
作者：
Kuiken T;Fouchier RA;Schutten M;Rimmelzwaan GF;van Amerongen G;van Riel D;Laman JD;de Jong T;van Doornum G;Lim W;Ling AE;Chan PK;Tam JS;Zambon MC;Gopal R;Drosten C;van der Werf S;Escriou N;Manuguerra JC;Stöhr K;Peiris JS;Osterhaus AD
通讯作者：
Osterhaus AD
DOI：
10.1016/s0140-6736(03)13364-8
发表时间：
2003-05-17
期刊：
Lancet (London, England)
影响因子：
--
作者：
Hon KL;Leung CW;Cheng WT;Chan PK;Chu WC;Kwan YW;Li AM;Fong NC;Ng PC;Chiu MC;Li CK;Tam JS;Fok TF
通讯作者：
Fok TF
影响因子：
19.7
作者：
Wong, KT;Antonio, GE;Ahuja, AT
通讯作者：
Ahuja, AT
DOI：
10.1016/s0140-6736(03)13414-9
发表时间：
2003-05-24
期刊：
Lancet (London, England)
影响因子：
--
作者：
Ruan YJ;Wei CL;Ee AL;Vega VB;Thoreau H;Su ST;Chia JM;Ng P;Chiu KP;Lim L;Zhang T;Peng CK;Lin EO;Lee NM;Yee SL;Ng LF;Chee RE;Stanton LW;Long PM;Liu ET
通讯作者：
Liu ET