嚴重急性呼吸道徵候群對第一線工作人員院內感染所導致腹瀉之探討

A Study of Diarrhea in Medical Workers with Severe Acute Respiratory Syndrome

冠狀病毒感染會導致呼吸道或胃腸道疾病，而嚴重急性呼吸道徵候群(SARS)，所攻擊目標器官是肺部。故本研究要探討的重點，在於第一線工作醫護人員照顧嚴重急性呼吸道徵候群之病患，有可能經呼吸道傳染到冠狀病毒而引發之胃腸道症狀「腹瀉」。自民國92年5月1日至6月16日，本院有十六位第一線醫護工作人員，被診斷為疑似嚴重急性呼吸道徵候群(SARS)。包括醫師五位，護士八位及呼吸治療師三位，他們曾明顯地與嚴重急性呼吸道徵候群(SARS)的指標病例有緊密接觸史。冠狀病毒RNA是用反錄型的聚合多鏈反應酶(RT-PCR)來檢測，共偵測喉頭檢體十六例，血清檢體二例及肛門檢體七例。腹瀉乃經由病歷上登錄為主，另用Fisher統計方法分析。結果，男性五例、女性十一例，平均年齡28.6歲。第一線工作之醫護人員為照顧嚴重急性呼吸道徵候群之病患，有可能經呼吸道傳染到冠狀病毒而引發之胃腸道症狀，其導致腹瀉之發生率為18.8％(3/16)，死亡率為6.25％(1/16)。根據報告顯示，院內第一線工作之醫護人員，經呼吸道可能感染到嚴重急性呼吸道徵候群之同時，其腹瀉病症狀並不常見。醫護人員照顧嚴重急性呼吸道徵候群之病患，為病患插管時經呼吸道感染為主，因此，胃腸道的病毒數量較低，可見於肛門採檢反錄聚合多鏈反應酶(RT-PCR)檢查，所以檢體檢測到陽性率較低及胃腸道症狀不明顯可能有關係。第一線工作之醫護人員感染嚴重急性呼吸道徵候群合併急性腹瀉之調查，腹瀉可能與本身個體性（心理性）或體質性（生理性）之大腸急躁症有關，需要從臨床的角度來探討。

The purpose of this study was to investigate the enteric symptoms of the medical workers who were evidently infected with SARS by means of respiratory transmission. Between May 1 and June 16, 2003, we examined 16 medical workers who were diagnosed with the probable SARS. Samples used for the detection of coronavirus RNA by RT-PCR were collected from throat and rectal swabs during acute phase. Serum anti-SARS IgG was checked by ELISA at the convalescent phase. The incidence of watery diarrhea was 18.8% (3/16). The RT-PCR of coronavirus was positive in three (18.8%) of sixteen throat swabs and in none (0%) of seven rectal swabs. Serum anti-coronavirus IgG was positive in 13 of the 15 subjects (86.7%). The mortality rate was 6.25% (1/16). In conclusion, Hospital-acquired SARS cases were infected mainly by respiratory route and less commonly presented with diarrhea. Low common diarrhea rate and low positive rate in rectal swab RT-PCR, when the virus spreaded by respiratory route, might be due to less intestinal viral load. According to the clinical observation, the psychological factor with stress could be the reason of functional gastrointestinal disorder leading to the diarrhea symptom.