SARS临床及免疫.docVIP

严重急性呼吸综合征临床特征及免疫异常研究 刘景院 郭利民 蔡皓东 赵红心 董庆华 郭 霞 王光敏 陈京龙 王凌航 何忠平 [摘要]：目的：研究SARS病人临床特征、治疗并探讨免疫发病机制。方法：52例确诊SARS病人, 35例1周内入院者进行联合抗病毒治疗，17例1周后入院者均在院外接受过大剂量糖皮质激素治疗者为对照，探索SARS治疗方法。检测病人不同阶段T淋巴细胞亚群、B细胞、NK细胞水平及血常规淋巴细胞计数，研究SARS病人免疫功能变化规律。结果：SARS病人69%具有双峰热型特点，病程可分为四个阶段：发热期、肺损伤期、免疫麻痹期、恢复期。早期抗病毒治疗重症发生率低8.5%（3/35），死亡率低（0/35）。早期大剂量应用糖皮质激素重症发生率41.2%（7/17），死亡率41.2%（7/17），死亡均与严重机会感染有关。SARS病人起病初即有T细胞、B细胞、NK细胞下降，在病程8-12天降至最低，普通病人第3周恢复正常，重型死亡病例持续低下。血常规淋巴细胞计数与流式细胞仪CD4+、CD8+T细胞计数直线相关，可代替后者观察病情。结论：SARS病人存在急性细胞免疫缺陷, 早期联合抗病毒治疗有较好疗效，不宜早期大量应用糖皮质激素治疗。 [关键词]：SARS；细胞免疫；抗病毒治疗；糖皮质激素 [Abstract] Objective To study the clinical features, immunologic mechanism, and therapy in patients with SARS . Methods Take 52 patients with SARS as example to study SARS treatment, 35 cases started to therapy with combination of antiviral agents less than 1 week after onset, 17 cases who had accepted large dosage corticosteroid more than 1 week before admission as contrast group. Measured T lymphocyte subgroup, B lymphocyte, NK cell, routine blood test, to study the change of immune function during SARS course. Results 69% patients had double peak fever type, the course of SARS can defined four stages: fever stage, lung injury stage, immunodeficiency stage, and recover stage. Antiviral therapy can decline fatality rate early stage of disease. T lymphocyte, B lymphocyte and NK cell count decreased obviously on early stage, and declined to the lowest level during 8~12 days of course, recovered in the 3th week in general patients，But continued at lower level in severe patients. There are liner correlation between The lymphocyte count of the routine blood test and CD4+、CD8+T cell count. Conclusion SARS patients presented acute cell immunodeficiency. the combination treatment of antiviral agents may acquire good efficacy in early stage. It’s not fit that using large dosage corticosteroid in early stage of SARS. [Key words] Severe acute respiratory syndrome (SARS), Cell immune, Antiviral therapy, Corticosteroid 近期在中