台灣地區「嚴重性呼吸道症候群」之臨床研究─（子計畫二）長期追蹤嚴重急性呼吸道症候群病患之肺部機能後遺症
Date Issued
2004
Date
2004
Author(s)
余忠仁
DOI
923112B002042
Abstract
Between Feb to August, 2003, in more than 29 countries, 8096 cases and causing more 774
deaths (fatality rate 9.6%). In Taiwan, 37 out of 346 SARS victims died, most of deaths were
attributed to severe acute respiratory distress syndrome (ARDS).
Pulmonary sequelae is especially anticipated in patients developing severe pulmonary infection
or acute lung injury. Survivors of the acute respiratory distress syndrome have persistent
functional disability one year after discharge from the intensive care unit. As the clinical
experience of dealing with SARS is accumulating, studies prospectively evaluating physiological,
functional, and morphological measures during the year after diagnosis of SARS will provide
valuable information for clinicians to handle patients with this new disease.
From April, 2003 till now, 76 patients with documented SARS were admitted to our hospital,15
died of the disease. Forty of the survivors received first HRCT examination at 51.8 ±20.2 days
after symptom onset, 37 received pulmonary function examination ；140.7 ±26.7 after symptom
onset,19 received a second HRCT examination ，22 had a second pulmonary function
examinations 。HRCT of lung parenchymal change revealed air trapping (92.5%), ground-glass
opacity (90%), reticulation (70%), parenchymal band (55%), bronchiectasis (17.5%),
consolidation (10%), and honeycombing (7.5%) in the first follow-up study. SARS patients who
experienced ARDS (n=16) had significantly higher scores than those without ARDS (n=24) in ground-glass opacity. Twelve of the 37 patients (37%) showed variable degrees of restrictive
ventilatory defects in first PFT examiantion and 11 of them had been complicated by ARDS. On
the first PFT patients without ARDS had better test results than those complicated by ARDS.
Comparison between the first and second follow-up HRCT of 19 cases revealed significant
improvement in ground glass opacity (CT scores 8.68 ±6.96 vs. 4.42 ±5.14, p < 0.0001) and
fibrosis (CT scores 5.79 ±6.13 vs. 3.05 ±5.80, p < 0.0001). All these impairments in PFT improved
2 months later. The FVC (% predicted) values improved from 71.3 ± 23.4 to 98.1 ± 19.6% (p =
0.004) and the FEV1 (% predicted) increased from 73.9 ± 21.0 to 96.5 ± 17.9% (p = 0.005). Most
HRCT and PFT parameters in patients with SARS-ARDS significantly improved on the second
examinations, but a restrictive defect was still present in 5 of the 10 patients (50%), probably
because of residual pulmonary fibrosis. The DLco (% predicted) was inversely correlated with the
total fibrotic scores on the high-resolution computed tomography (HRCT) of the chest. Our
observation study revealed that lung damage in SARS patients usually resolve over time. The
DLco may be a useful marker to follow-up fibrosis sequelae.
Subjects
severe acute respiratory syndrome
acute respiratory distress syndrome
high-resolution computed tomography
pulmonary function test
diffusion capacity
Publisher
臺北市：國立臺灣大學醫學院內科
Type
report
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