[Glucocorticoid in the treatment of severe acute respiratory syndrome patients: a preliminary report].

OBJECTIVE: To discuss the effect of glucocorticoid (methylprednisolone) on severe acute respiratory syndrome (SARS). METHODS: Thirty SARS patients were treated at our hospital for over 3 weeks since March to May 2003. The course and dosage of glucocorticoid, counts of CD(4)(+), CD(8)(+) and CD(3)(+), electrolytes, blood routine, and sera albumin before and after the treatment were analysed. RESULTS: Before treatment by methylprednisolone, the counts of CD(4)(+), CD(8)(+) and CD(3)(+) of 27 SARS patients were (401 +/- 203), (340 +/- 187), (756 +/- 383) cells/ microl. Twenty-nine of the 30 SARS patients were treated by methylprednisolone. The dosage for 24 patients was 80 - 160 mg/d with the largest being 1,000 mg/d before admission to the hospital. The count of WBC was increased after treatment (P < 0.01). No obvious effect was observed on the potassium, sodium and chlorine of blood (P > 0.05). Glucocorticoid increased the level of blood glucose (P = 0.01), decreased the level of sera albumin (P < 0.01), and its large dosage decreased the counts of CD(4)(+), CD(8)(+) and CD(3)(+). Three severe patients had secondary infection after administration of a large dose of glucocorticoid. CONCLUSIONS: In the early stage of the disease, the counts of CD(4)(+), CD(8)(+) and CD(3)(+) of SARS patients may reduce markedly indicating the immunity is suppressed. A large dose of glucocorticoid may aggravate the suppression and make the body in an active metabolic state (the increase of blood glucose and the decrease of sera albumin). Thus the disease is aggravated and patients are likely to suffer from severe secondary infection. Indications for use of glucocorticoid must strictly controlled and its large dosage is improper.

[Clinical analysis of SARS: 27 cases report].

OBJECTIVE: To realize the clinical characteristic of severe acute respiratory syndrome (SARS). METHODS: Observe the clinical signs and symptoms of each patients; do laboratory examination periodically; and at last do Stat analysis of all the cases. RESULTS: The first onset symptom of the 27 cases is high fever accompany with toxic symptom such as muscular soreness, headache, etc. The patient's condition may be most serious in the 2nd week. The amount of end-brush blood WBC decrease, especially the lymphocyte decrease more obviously. The amount of CD(4)(+) and CD(8)(+) decrease obviously is another important characteristic. The chest X-ray show pulmonary lesion in the 2nd day after onset of the illness, but 40.7% cases show positive change after 6 days onset. During the 7 - 12 days the pulmonary lesion become most serious. Seven cases are treated by steroid in the first 3 days when the chest X-ray is normal, but they become positive during 6 - 8 days of the course. Whether the state of the illness is serious or not seems no obvious relationship to when they are treated by steroid. And large dosage of steroid may inhibit the level of CD(4)(+) and CD8 (P < 0.05). Two severe cases present double infection after large dosage of steroid. CONCLUSION: The course of a infectious atypical pneumonia is almost 3 weeks, the 1st week can be decided as early stage, the 2nd week is decided as fastigium, the 3rd week is decided as stage of recovery. During the fastigium, the disease transform very quickly, we need pay more attention to the patient. The CD(4)(+), CD(8)(+) and CD(3)(+) of SARS patient decrease obviously, it seems the immuno-function inhibited seriously. The serious case is easily accompany with severe secondary infection in the late stage, so the use of steroid must be carefully and the dosage need not to be much more.