Department of Radiology, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, No. 1665 Kongjiang Road, Yangpu District, Shanghai 200092, China.
Department of Radiology, Maternal and Child Health Hospital of Hubei Province, No.745 Wuluo Road, Hongshan District, Wuhan 430070, Hubei Province, China.
J Infect. 2020 May;80(5):e7-e13. doi: 10.1016/j.jinf.2020.03.007. Epub 2020 Mar 21.
The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.
Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.
Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0·007, P < 0·001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0·001, P < 0·001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans.
Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT.
目前，新型冠状病毒肺炎（COVID-19）疫情在全球蔓延，形势严峻。我们旨在探讨妊娠患者的临床及 CT 特征，目前针对此类患者的研究报道较少。
回顾性分析 2020 年 1 月 27 日至 2 月 14 日期间 59 例 COVID-19 患者的临床和 CT 资料，包括 14 例实验室确诊的非妊娠成人、16 例实验室确诊和 25 例临床诊断的妊娠妇女以及 4 例实验室确诊的儿童。分析并比较了患者的临床和 CT 特征。
与非妊娠成人组（n=14）相比，实验室确诊组（n=16）和临床诊断组（n=25）中初始体温正常（9 例[56%]和 16 例[64%]）、白细胞增多（8 例[50%]和 9 例[36%]）和中性粒细胞比例升高（14 例[88%]和 20 例[80%]）以及淋巴细胞减少（9 例[56%]和 16 例[64%]）更为常见。54 例（98%）和 37 例（67%）患者的 CT 表现均以双侧外周病变为主，分别检测到 614 个和 374 个病变。非妊娠成人中，单纯磨玻璃密度影（GGO）病变最为常见（94/131，72%）。与非妊娠成人组（37/131，28%）相比，实验室确诊组（70/161，43%）和临床诊断组（153/322，48%）中混合性实变和完全实变更为常见（P=0.007，P<0.001）。非妊娠成人中 GGO 伴网状影（24/131，18%）较妊娠妇女组（9/161，6%和 16/322，5%）更为常见（P=0.001，P<0.001）。儿童 COVID-19 的肺部受累较轻，表现为局灶性 GGO 或实变。23 例患者进行了随访 CT，与初次 CT 扫描相比，第 3 天有 9/13（69%）例患者病情进展，第 6~9 天有 8/10（80%）例患者病情改善。
妊娠患者 COVID-19 的临床表现可能不典型，增加了初始诊断的难度。妊娠妇女组中实变更为常见。临床诊断组更易出现肺部受累。CT 是 COVID-19 患者具有流行和临床特征，无论是否有实验室确诊，进行早期发现、严重程度评估和及时治疗效果评价的首选方法。对于有疫情接触史和临床症状的患者，CT 检查有助于筛查，而对于儿童，临床症状比胸部 CT 更有帮助。
