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新型冠状病毒肺炎的临床特征及高分辨率CT影像学演变

[Clinical features and high resolution CT imaging evolution of coronavirus disease 2019].

作者信息

Lu X F, Gong W, Wang L, Li L, Xie B J, Peng Z F, Zha Y F

机构信息

Department of Radiology, Renmin Hospital of Wuhan University, Wuhan 430060, China.

出版信息

Zhonghua Jie He He Hu Xi Za Zhi. 2020 Jun 12;43(6):509-515. doi: 10.3760/cma.j.cn112147-20200214-00094.

Abstract

To investigate the clinical manifestations of the clinical characteristics of 141 patients with coronavirus disease 2019 (COVID-19) and the imaging evolution characteristics of High Resolution CT (HRCT) in the chest. From January 20, 2020 to February 8, 141 COVID-19 patients in Renmin Hospital of Wuhan University, 77 males and 64 females, with a median age of 49 (9,87) , were retrospectively analyzed. The clinical features, laboratory examination indexes and HRCT evolution findings of 141 COVID-19 patients were analyzed. Laboratory examinations of 141 COVID-19 patients showed a decrease in white blood cell count and lymphocyte ratio. Among the 141 patients with COVID-19, fever (>37.5 ℃) was the most common clinical manifestation in 139 cases (98.58%) , and occasionally non-respiratory symptoms such as diarrhea in 4 cases (2.84%) . 141 patients with COVID-19 had abnormal HRCT. 52 (36.88%) chest HRCT images showed ground-glass opacity (GGO) , mainly under pleural; 23 (16.31%) GGO with focal consolidation; 27 (19.15%) small flaky shadows; 20 cases (14.18%) large flaky consolidation shadows; 48 cases (34.04%) bronchovascular bundle thickening and vascular penetrating signs; 5 cases (3.55%) had air bronchial signs; 7 cases (4.96%) of small nodule shadows; 5 cases (3.55%) of fibrosis, grid shadows or strand shadows.135 cases (95.74%) were positive for the first time nucleic acid test, 6 cases (4.26%) were negative, and 71 cases (50.35%) of common type, 47 cases (33.33%) of severe type and 23 cases (16.31%) of critical type were found during the same period. The average time from onset of each type to the first CT examination was: (2.51±1.32) , (5.02±2.01) , and (5.91±1.76) days; 19 (19/47, 40.43%) of which were severe for the first time CT classification worsened at the second examination and lessened at the third examination. 141 cases (100%) were positive for the second nucleic acid test, and the HRCT results for the same period were 44 cases (31.21%) of common type, 53 cases (37.59%) of severe type, and 44 cases (31.21%) of critical type; the average interval time was (3.32±1.61) , (3.93±1.84) , (4.15±1.57) days;the third nucleic acid test were positive among 113 cases and 28 cases were negative, HRCT results of the same period were 79 cases (56.03%) of common type, 46 cases (32.62%) of severe type, and 16 cases (11.35%) of critical type;the average interval from the first CT examination were: (5.59±1.83) , (7.32±1.37) , (7.55±1.78) days. The differences in CT typing at different time were statistically significant (0.05) . The clinical features of COVID-19 and HRCT images are diverse, extensive GGO and infiltrates in both lungs are typical. Viral nucleic acid tests usually occur earlier or at the same time as the CT examination positive, and there are false negatives in nucleic acid tests. In some epidemiological backgrounds, CT imaging manifestations and evolutionary characteristics are of great significance for early warning of lung injury, assessment of disease severity, and assistance in clinical typing and post-treatment follow-up.

摘要

探讨141例新型冠状病毒肺炎(COVID-19)患者的临床特征及胸部高分辨率CT(HRCT)影像演变特征。回顾性分析2020年1月20日至2月8日武汉大学人民医院收治的141例COVID-19患者,其中男性77例,女性64例,年龄中位数为49(9,87)岁。分析141例COVID-19患者的临床特征、实验室检查指标及HRCT演变结果。141例COVID-19患者实验室检查显示白细胞计数及淋巴细胞比例降低。141例COVID-19患者中,发热(>37.5℃)139例(98.58%)为最常见临床表现,4例(2.84%)偶尔出现腹泻等非呼吸道症状。141例COVID-19患者HRCT均有异常。胸部HRCT图像表现为磨玻璃影(GGO)52例(36.88%),主要位于胸膜下;GGO伴局灶实变23例(16.31%);小片状影27例(19.15%);大片状实变影20例(14.18%);支气管血管束增粗及血管穿行征48例(34.04%);空气支气管征5例(3.55%);小结节影7例(4.96%);纤维化、网格影或条索影5例(3.55%)。首次核酸检测135例(95.74%)阳性,6例(4.26%)阴性,同期发现普通型71例(50.35%)、重型47例(33.33%)、危重型23例(16.31%)。各型从发病至首次CT检查的平均时间分别为:(2.51±1.32)、(5.02±2.01)、(5.91±1.76)天;其中19例(19/47,40.43%)重型患者首次CT分类在第二次检查时加重,第三次检查时减轻。第二次核酸检测141例(100%)阳性,同期HRCT结果为普通型44例(31.21%)、重型53例(37.59%)、危重型44例(31.21%);平均间隔时间分别为(3.32±1.61)、(3.93±1.84)、(4.15±1.57)天;第三次核酸检测113例阳性,28例阴性,同期HRCT结果为普通型79例(56.03%)、重型46例(32.62%)、危重型16例(11.35%);距首次CT检查的平均间隔分别为:(5.59±1.83)、(7.32±1.37)、(7.55±1.78)天。不同时间CT分型差异有统计学意义(P<0.05)。COVID-19的临床特征及HRCT图像多样,双肺广泛GGO及渗出为典型表现。病毒核酸检测通常早于或与CT检查阳性同时出现,核酸检测存在假阴性。在某些流行病学背景下,CT影像表现及演变特征对肺部损伤预警、病情严重程度评估、临床分型及治疗后随访有重要意义。

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