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目的:研究SARS病人临床特征及其免疫发病机制和治疗。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例在院外接受过大剂量糖皮质激素组1周以上者为对照,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,病情演变呈阶段性,可分为四个时期:发热期、肺损伤期、免疫麻痹期、恢复期。早期以联合抗病毒治疗35例,重症3例,无1例死亡;早期大剂量应用糖皮质激素者17例,重症7例,死亡7例,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T细胞亚群直线相关,可代替后者观察病情。结论:SARS病人主要矛盾是免疫力低下,病毒直接杀伤淋巴细胞可能是其原因。早期联合抗病毒治疗有较好疗效,不宜应用大量糖皮质激素治疗。
Objective: To study the clinical characteristics of SARS patients and their immune pathogenesis and treatment. Methods: Fifty-two patients with confirmed SARS and 35 patients admitted to hospital within one week were treated with combined antiviral therapy. Seventeen patients who received high-dose glucocorticosteroid for more than one week were compared with each other to explore SARS treatment. T lymphocyte subsets, B cells, NK cells and blood lymphocyte counts at different stages of the patient were detected to study the changes of immune function in patients with SARS. Results: 69% of patients with SARS had the characteristic of bimodal fever. The disease evolution was staged and divided into four periods: fever, lung injury, immune paralysis and recovery. In the early stage, 35 cases were treated with combined antiviral therapy, 3 cases were severe and none died. Early large dose of glucocorticoid was used in 17 cases, severe cases in 7 cases and death in 7 cases. The death was associated with severe opportunistic infections. At the beginning of the onset of SARS, T cells, B cells and NK cells decreased. The duration of the disease dropped to a minimum from 8 days to 12 days. Normal patients returned to normal in the third week and the number of heavy deaths remained low. Blood lymphocyte count and flow cytometry T cell subsets linear correlation can replace the latter to observe the disease. Conclusion: The main contradiction of SARS patients is the low immunity. The direct killing of lymphocytes by the virus may be the reason. Early combination antiviral therapy has a good effect, not a lot of glucocorticoid treatment.