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目的 :在严重急性呼吸综合征 (SARS)流行的背景下 ,为SARS和其它病毒性肺炎进行诊断和鉴别诊断提供依据。方法 :对上海市第五人民医院 2 0 0 3年 4月 12日～ 6月 5日收治的 10例成人社区获得性病毒性肺炎流行病学史、临床特征、实验室检查、微生物学检查、影像学、治疗和预后进行回顾性分析。结果 :符合SARS流行病学特点 1例 (10 % ) ,符合流感流行病学特点 3例 (30 % )。主要临床症状 :发热 (10 0 % )、咳嗽 (70 % )。就诊时白细胞 (WBC)计数减低 3例 (30 % ) ,中性粒细胞百分比(NEUT % )增高 5例 (5 0 % ) ,淋巴细胞百分比 (LYMPH % )减少者 3例 (30 % )。病原学检查 :流感病毒 7例 (70 % ) ,副流感病毒 2例 (2 0 % ) ,1例SARS病原学检查结果阴性。就诊时异常的胸部X线片表现以肺实质阴影为主。进展 3例 (30 % ) ,阴影在下肺 9例 (90 % )、心缘旁 3例 (30 % )、单侧 9例 (90 % )、双侧 1例 (10 % )。全部病例经治疗后痊愈出院。结论 :相对SARS ,成人社区获得性流感病毒性肺炎具有发热不反复、肺内病灶单发、病程短、预后好的特点 ,对SARS的诊断更应注意流行病学及恰当时机反复病原学检测。
Objective: To provide a basis for the diagnosis and differential diagnosis of SARS and other viral pneumonia in the context of the epidemic of severe acute respiratory syndrome (SARS). Methods: The epidemiological history, clinical features, laboratory tests, microbiology tests of 10 cases of acquired viral pneumonia in adults admitted to Shanghai Fifth People’s Hospital from April 12 to June 5, 2003, Imaging, treatment and prognosis were retrospectively analyzed. Results: In line with the epidemiological characteristics of SARS in 1 case (10%), in line with the epidemiological characteristics of influenza in 3 cases (30%). The main clinical symptoms: fever (100%), cough (70%). There were 3 cases (30%) of white blood cell count (WBC) reduction, 5 cases of neutrophil (5%) and 3 cases (30%) of decreased lymphocyte percentage (LYMPH%) on treatment. Etiological examination: 7 cases of influenza virus (70%), 2 cases of parainfluenza virus (20%), 1 case of SARS etiology test results were negative. Abnormal chest X-ray presentation at the time of treatment showed substantial pulmonary shadows. There were 3 cases (30%) with progression in the lower lung, 9 cases (90%) in the lower lung with shadow in 3 cases (30%), 9 cases (90%) unilateral and 1 case (10%) bilateral. All cases were cured after treatment and discharged. Conclusion: Compared with SARS, adults with acquired influenza virus pneumonia have the characteristics of repeated fever, single pulmonary lesion, short course of disease and good prognosis. Epidemiological and opportunistic repeated pathogen detection should be paid more attention to the diagnosis of SARS.