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（陈亚岗 朱彪）
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内科学新进展 第二节 严重急性呼吸综合征
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摘 要 严重急性呼吸综合征（severe acute respiratory syndrome, SARS）是一种新的急性呼吸道传染病，该病由SARS冠状病毒（SARS-coronavirus, SARS-CoV）引起，具有传染性强、流行面广、病死率较高等特点。临床上以进展性病毒性肺炎为特征，表现为发热、乏力、头痛、肌肉关节酸痛等全身症状和干咳、胸闷、呼吸困难等呼吸道症状为主要表现，腹泻等消化道症状是最常见的肺外表现；胸部影像学检查可见毛玻璃样改变以及局部实变；实验室检查外周血白细胞计数正常或降低；抗菌药物治疗无效是其重要特征。重症病例表现明显的呼吸困难，并可迅速发展成为急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS)。诊断主要以流行病史，临床特征以及实验室检查为主，病原学检查进一步明确SARS的诊断。治疗上主要为对症支持，正确合理地使用糖皮质激素。
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Abstract Severe acute respiratory syndrome（SARS）is a novel infectious respiratory diseases caused by a novel coronavirus（the SARS-coronavirus, SARS-CoV）with intensive infectivity and high mortality. The typical clinical presentation of SARS is that of viral pneumonia with rapid respiratory deterioration. Fever, malaise, headache, myalgia, nonproductive cough and dyspnoea are the major symptoms. Diarrhea is the most common extrapulmonary manifestation. Chest radiographs typically show ground-glass opacities and focal consolidations.
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Laboratory abnormalities in SARS include lymphopenia, while total white blood cell counts are normal or slightly low, Administration of antibiotic has no improvement for SARS patient, which is another important clinical feature. In severe cases, respiratory function may occur and progress to acute respiratory distress syndrome（ARDS). The diagnosis of SARS is mainly based on the clinical, epidemiologic, and laboratory features, which will be further confirmed by the pathogenic examination. Clinical management of SARS has relied largely upon supportive care, and the use of corticosteroids should be appropriately managed.
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严重急性呼吸综合征（severe acute respiratory syndrome, SARS）是一种新的急性呼吸道传染病，具有传染性强、流行面广、病死率较高等特点。在我国该病称为传染性非典型肺炎。该病由SARS冠状病毒（SARS-coronavirus, SARS-CoV）引起，是可累及多个脏器系统的特殊肺炎，临床上以发热、乏力、头痛、肌肉关节酸痛等全身症状和干咳、胸闷、呼吸困难等呼吸道症状为主要表现，部分病例可有腹泻等消化道症状；胸部X线检查可见肺部炎性浸润影；实验室检查外周血白细胞计数正常或降低；抗菌药物治疗无效是其重要特征。重症病例表现明显的呼吸困难，并可迅速发展成为急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS)。截至2003年8月7日，全球累计发病例数为8422例，依据报告病例计算的平均病死率达到了9.3％。SARS是21世纪第一个发现的烈性传染病，我国已将SARS按照甲类传染病处置。
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一、流行病学
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（一）流行分布
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2002年11月，在我国广东发现第一个SARS病例。至2003年2月，广东发病进入高峰。在经历了两个多月的始发期后，扩散到我国内地24个省、自治区、直辖市。在全球共
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波及亚洲、美洲、欧洲等32个国家和地区。截止2003年8月7日，全球累计发病例数为8422例，中国内地总发病数达5327例。2004年，在我国台湾发现1例实验室感染的SARS患者，之后我国广东省出现4例经病原学确诊的SARS患者。目前全球没有SARS患者和SARS疫区。
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（二）传染源
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SARS患者是最主要传染源。极少数患者在刚出现症状时即具有传染性。一般情况下传染性随病程而逐渐增强，在发病的第2周最具传播力。通常认为症状明显的患者传染性较强，特别是持续高热、频繁咳嗽、出现ARDS时传染性较强。退热后传染性迅速下降，尚未发现潜伏期患者以及治愈出院者有传染他人的证据。尚未发现隐性感染者的传染性。一般认为，症状不典型的轻型患者不是重要的传染源。迄今尚未证实有长期带毒者。
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（三）传播途径
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