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回顾性分析宣武医院2003年5月至6月收治的212例严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)患者的临床资料,观察患者发病前合并的基础疾病与死亡及出院时胸片吸收情况的关系。发现有基础疾病的患者,病死率(20.7%)显著高于无基础疾病患者(4.5%,P=0.000);合并2种或者2种以上基础疾病的患者,病死率明显高于合并一种基础疾病及无基础疾病的患者(P值分别为0.008、0.000);在糖尿病、高血压、冠心病、脑血管疾病、慢性阻塞性肺病、肝炎/肝硬化6种疾病中,采用Logistic回归分析,发现脑血管病、肝炎/肝硬化是SARS患者死亡的主要危险因素(P值分别为0.000、0.001),糖尿病未明显增加SARS患者的病死率。治愈的SARS患者,合并基础疾病组胸片遗留病变者(60.4%)显著高于无基础疾病组(29.9%,P=0.001)。提示SARS患者合并基础疾病者病死率明显升高,随着合并的基础疾病的增多,病死率明显上升。肝炎/肝硬化及脑血管病是死亡的危险因素;基础疾病使SARS患者肺部损伤加重、恢复慢。糖尿病未明显增加SARS患者的病死率,提示糖尿病可能对患者避免SARS引起的急性肺损伤起一定作用。
The clinical data of 212 patients with severe acute respiratory syndrome (SARS) who were admitted to Xuanwu Hospital from May to June 2003 were retrospectively analyzed. The relationship between the underlying diseases before the onset of illness and the death and the absorption of the chest radiograph at discharge was observed . The patients with underlying diseases had a significantly higher case fatality rate (20.7%) than those without underlying diseases (4.5%, P = 0.000). Patients with two or more underlying diseases had a significantly higher case fatality rate than those with one (P = 0.008,0.000, respectively). Logistic regression analysis showed that among the six diseases of diabetes, hypertension, coronary heart disease, cerebrovascular disease, chronic obstructive pulmonary disease and hepatitis / cirrhosis, it was found that Cerebrovascular disease and hepatitis / cirrhosis are the major risk factors for death in patients with SARS (P = 0.000 and 0.001). Diabetes did not significantly increase the mortality of SARS patients. Among the patients with cured SARS, the number of patients with chest wall lesions in combination group (60.4%) was significantly higher than that in patients without underlying diseases (29.9%, P = 0.001). Prompted the SARS patients with underlying diseases were significantly higher mortality, with the increase in underlying diseases, mortality increased significantly. Hepatitis / cirrhosis and cerebrovascular disease are the risk factors for death. The underlying diseases aggravate lung injury and slow recovery in patients with SARS. Diabetes did not significantly increase the mortality of patients with SARS, suggesting that diabetes may play a role in patients with acute lung injury caused by SARS.