A major outbreak of severe acute respiratory syndrome in Hong Kong
A major outbreak of severe acute respiratory syndrome in Hong Kong
复制标题
DOI：
10.1056/nejmoa030685
复制
发表时间：
2003-05-15
影响因子：
158.5
通讯作者：
Sung, JJY
中科院分区：
文献类型：
--
作者：
Lee, N;Hui, D;Sung, JJY
背景严重急性呼吸综合征(SARS)已在全球范围内暴发。我们报告了在香港医院爆发的138例疑似SARS患者的临床、实验室和放射学特征。方法2003年3月11日至25日，所有与指示病人或病房接触的疑似SARS患者都被送往威尔斯亲王医院的隔离病房。分析他们的人口学、临床、实验室和放射学特征。临床终点包括需要重症监护和死亡。结果队列中有66名男性患者和72名女性患者，其中69人为医护人员。最常见的症状包括发烧(100%的患者)；发冷、僵硬或两者兼而有之(73.2%)；以及肌肉痛(60.9%)。据报道，超过50%的患者还出现了咳嗽和头痛。其他常见的发现是淋巴细胞减少(69.6%)，血小板减少(44.8%)，以及乳酸脱氢酶和肌酸激酶水平升高(分别为71.0%和32.1%)。胸部CT扫描常可见周围间隙实变。共有32名患者(23.2%)进入重症监护病房；5名患者死亡，所有患者都有共存的情况。在多变量分析中，不良结局的独立预测因素是高龄(每十年寿命的优势比，1.8；95%可信区间，1.16至2.81；P=0.009)，高峰值乳酸脱氢酶水平(每100U/升的优势比，2.09；95%可信区间，1.28至3.42；P=0.003)，以及中性粒细胞绝对计数超过正常范围的上限(优势比，1.6；95%可信区间，1.03至2.5；结论SARS是一种严重的呼吸系统疾病，在我们的队列中导致显著的发病率和死亡率。
BACKGROUNDThere has been an outbreak of the severe acute respiratory syndrome (SARS) worldwide. We report the clinical, laboratory, and radiologic features of 138 cases of suspected SARS during a hospital outbreak in Hong Kong.METHODSFrom March 11 to 25, 2003, all patients with suspected SARS after exposure to an index patient or ward were admitted to the isolation wards of the Prince of Wales Hospital. Their demographic, clinical, laboratory, and radiologic characteristics were analyzed. Clinical end points included the need for intensive care and death. Univariate and multivariate analyses were performed.RESULTSThere were 66 male patients and 72 female patients in this cohort, 69 of whom were health care workers. The most common symptoms included fever (in 100 percent of the patients); chills, rigors, or both (73.2 percent); and myalgia (60.9 percent). Cough and headache were also reported in more than 50 percent of the patients. Other common findings were lymphopenia (in 69.6 percent), thrombocytopenia (44.8 percent), and elevated lactate dehydrogenase and creatine kinase levels (71.0 percent and 32.1 percent, respectively). Peripheral air-space consolidation was commonly observed on thoracic computed tomographic scanning. A total of 32 patients (23.2 percent) were admitted to the intensive care unit; 5 patients died, all of whom had coexisting conditions. In a multivariate analysis, the independent predictors of an adverse outcome were advanced age (odds ratio per decade of life, 1.80; 95 percent confidence interval, 1.16 to 2.81; P=0.009), a high peak lactate dehydrogenase level (odds ratio per 100 U per liter, 2.09; 95 percent confidence interval, 1.28 to 3.42; P=0.003), and an absolute neutrophil count that exceeded the upper limit of the normal range on presentation (odds ratio, 1.60; 95 percent confidence interval, 1.03 to 2.50; P=0.04).CONCLUSIONSSARS is a serious respiratory illness that led to significant morbidity and mortality in our cohort.