SARS的激素治疗与胸片所见

 【目的】探讨严重急性呼吸综合征（SARS）的糖皮质激素治疗与胸片所见的关系。【方法】收集广州市458例SARS患者的一般临床资料及每次胸片资料。所有患者都临床确诊并经免疫学检查证实,临床资料及胸片资料同时较齐全才作为研究对象。根据应用激素与否将其分为两组。【结果】应用激素组257例,未用激素组201例。两组在首次见到肺内病变时间之差异无统计学意义（t=1.417,P=0.157）;激素用于临床表现较严重的病例,胸片上肺内病变达高峰时间较未用激素组长（t=3.242,P=0.001）,所累及的肺小区个数较多（t=3.982,P〈0.001）,住院时间较长（F=2.731,P〈0.001）。始用激素于病程10d之内及10d之后比较,后者肺内病变达高峰时所累及的肺小区个数较多。最大日剂量较大者,其病变存留较久、住院时间较多（F=3.040,7.044;P〈0.001,〈0.001）。【结论】激素用于症状较重的SARS患者的情况下,病死率不高,提示激素在SARS治疗中有重要意义。

Glucocorticosteroids Therapy and Features on Chest Radiography in SARS Patients

[Objective] To explore the correlation between the radiological features on chest X-ray films in SARS patients and glucocorticosteroids (GCS) therapy. [Methods] To collect the clinical data and a series of chest X-ray films in 458 patients in Guangzhou. All the patients fulfilled the diagnostic criteria and confirmed by the immunology with an integrity clinical record and radiological data were recruited for this study. The patients were divided into two groups according to whether or not with GCS treatment. [Results] A total of 257 cases had used GCS and 201 cases did not in the course of SARS. There was no significant difference of the time of the initial abnormal appearances of lungs on chest X-ray films from the onset of symptoms between the two groups (t=1.417, P =0.157). GCS were used in the patients whose clinical manifestations were more serious. The GCS group had longer time stayed in hospital (F=2.731, P< 0.001) while the lesion of lung had longer time to peak level on chest X-ray films (t=3.242, P =0.001), involved more lung zones (t=3.982, P < 0.001) than the group who did not use GCS. At the peak level of lung lesion on the chest X-ray films, more lung zones were involved in the patients who had GCS therapy after 10 days from the onset than those patients who did it in the first 10 days. The course of the lesions in lung or the days of hospitalization were longer (F=3.040, 7.044; P< 0.001, < 0.001) in the patients whose the maximum dose once day were more. [Conclusion] GCS were used in the severity patients of SARS and the risk of fatality in the GCS group is not higher than the no GCS group. It is suggested that GCS therapy has important effect in the treatment of SARS.