CAJ | 학술논문

背景:传染性非典型性肺炎(severe acute respiratory syndrome,SARS)是一种新型冠状病毒所致的急性传染病,临床表现以肺脏的急性炎症性损伤为主,可合并心、脑、肾等多脏器损害,除躯体症状外,情感障碍是SARS患者的另一显著神经精神症状.目的:对SARS合并神经精神损害的临床特点进行分析总结.设计:以患者为观察对象,回顾性病例分析.单位:中山大学第二附属医院的神经科,呼吸科和放射科.对象:2003-02/05中山大学第二附属医院及广州市第八人民医院住院确诊SARS病例325例,其中出现神经精神症状者173例.方法:回顾分析325例SARS病例,其中173例出现神经精神症状,总结分析其临床资料.主要观察指标:神经精神损害的临床表现,眼底检查结果,部分死亡病例尸检病理结果.结果:①SARS神经精神症状发生率为53.2%,主要有以下几类:头痛116例(67.1%),头晕50例(28 9%),意识障碍18例(10.4%),精神障碍8例(4.6%),伴神经系统局灶定位体征者1例(0.6%),抽搐2例(1.2%),情感障碍53例(30.6%),其中焦虑35例(20.2%),抑郁11例(6.4%),自杀倾向2例(1.2%),恐惧13例(7.5%).②325例中,重症SARS 56例,伴发神经精神损害者47例,其发生率明显高于轻症(P＜0.01).③4例病例眼底检查显示视乳头边缘欠清晰,生理凹陷存在,静脉充盈.④2例死亡病例尸体解剖脑组织病理显示:脑组织出现不同程度的水肿,局部神经纤维出现脱髓鞘现象.结论:SARS神经精神损害症状多样,与病情轻重显著相关.病理检查可见脑水肿及神经元脱髓鞘等损害.
배경:전염성비전형성폐염(severe acute respiratory syndrome,SARS)시일충신형관상병독소치적급성전염병,림상표현이폐장적급성염증성손상위주,가합병심、뇌、신등다장기손해,제구체증상외,정감장애시SARS환자적령일현저신경정신증상.목적:대SARS합병신경정신손해적림상특점진행분석총결.설계:이환자위관찰대상,회고성병례분석.단위:중산대학제이부속의원적신경과,호흡과화방사과.대상:2003-02/05중산대학제이부속의원급엄주시제팔인민의원주원학진SARS병례325례,기중출현신경정신증상자173례.방법:회고분석325례SARS병례,기중173례출현신경정신증상,총결분석기림상자료.주요관찰지표:신경정신손해적림상표현,안저검사결과,부분사망병례시검병리결과.결과:①SARS신경정신증상발생솔위53.2%,주요유이하궤류:두통116례(67.1%),두훈50례(28 9%),의식장애18례(10.4%),정신장애8례(4.6%),반신경계통국조정위체정자1례(0.6%),추휵2례(1.2%),정감장애53례(30.6%),기중초필35례(20.2%),억욱11례(6.4%),자살경향2례(1.2%),공구13례(7.5%).②325례중,중증SARS 56례,반발신경정신손해자47례,기발생솔명현고우경증(P＜0.01).③4례병례안저검사현시시유두변연흠청석,생리요함존재,정맥충영.④2례사망병례시체해부뇌조직병리현시:뇌조직출현불동정도적수종,국부신경섬유출현탈수초현상.결론:SARS신경정신손해증상다양,여병정경중현저상관.병리검사가견뇌수종급신경원탈수초등손해.
BACKGROUND:Severe acute respiratory syndrome (SARS),an acute infection with a mutant coronavirus,is characterized by acute pulmonary inflammatory injury accompanied by possible multiple organ injuries. Besides somatic symptoms,affective disorder constitutes an obvious neuropsychiatric symptom in SARS patients.OBJECTIVE:To analyze the clinical features of SARS with neuropsychiatric involvement.DESIGN:A retrospective case analysis.SETTING:Department of Neurology,Department of Respiratory Diseases and Department of Radiology of Affiliated Hospital of Sun Yat-sen University.PARTICIPANTS:Totally 325 SARS patients treated in the Second Affiliated Hospital of Sun Yat-sen University and the 8th People's Hospital of Guangzhou from February 2003 to May 2003 were involved,including 173cases who developed neuropsychiatric symptoms.METHODS:The clinical data of 325 of SARS including 173 cases with neuropsychiatric symptoms were retrospectively analyzed.MAIN OUTCOME MEASURES:Clinical neuropsychiatric symptoms,ophthalmoscopic examination,and pathological findings in autopsy.RESULTS: ①The incidence of neuropsychiatric involvement was about 53.2% in SARS patients. The manifestations consisted mostly of headache (67.1%),dizziness(28.9%),conscious-ness disturbance(10.4%),mental disorder(4.6%), local orientational disorder(0.6%),seizures(1.2%),and affective disorders (30.6%);anxiety occurred in 20.2%,depression in 6.4%,suicidal tendency in 1.2%,and phobia in 7.5% of the patients with neuropsychiatric involvement. ②Among the 325 patients,56 were in critical condition of whom 47 had accompanying neuropsychiatric impairment,with significantly greater incidence than that in mild cases (P＜0.01). ③Ophthalmoscopic examination performed in 4 patients showed blurred margin of the optic disc with retinal venous congestion. ④Autopsy in 2 cases identified edema of the perivascular tissue and vascular wall of the small veins with mononuclear cell and lymphocyte infiltration,neuron degeneration and demyelination in focal brain tissues.CONCLUSION:The manifestations of neuropsychiatric involement can vary in association with the severity of SARS,and the typical pathological changes include edema,neuronal demyelination etc.in the brain.