Zou Wenbin, Liu Changyu, Cai Yixin, Zeng Zhilin, Zhang Ni, Fu Xiangning
Department of Thoracic Surgery.
Department of Infectious Disease,Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology,Wuhan 430030,China.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao. 2020 Jun 30;42(3):370-375. doi: 10.3881/j.issn.1000-503X.12691.
To investigate the computed tomographc(CT)features of mild/moderate and severe/critical cases of coronavirus disease 2019(COVID-19)in the recovery phase. Totally 63 discharged patients in Wuhan,China,who underwent both chest CT and reverse transcription-polymerase chain reaction(RT-PCR)from February 1 to February 29,2020,were included.With RT-PCR as a gold standard,the performance of chest CT in diagnosing COVID-19 was assessed.Patients were divided into mild/moderate and severe/critical groups according to the disease conditions,and clinical features such as sex,age,symptoms,hospital stay,comorbidities,and oxygen therapy were collected.CT images in the recovery phase were reviewed in terms of time from onset,CT features,location of lesions,lobe score,and total CT score. There were 37 patients in the mild/moderate group and 26 in the severe/critical group. Compared with the mild/moderate patients,the severe/critical patients had older age [(43±16) years (52±16) years; =2.10, =0.040], longer hospital stay [(15±6)d (19±7)d; =2.70, =0.009], higher dyspnea ratio (5.41% 53.85%; =18.90, <0.001), lower nasal oxygen therapy ratio (81.08% 19.23%;=23.66, <0.001), and higher bi-level positive airway pressure ventilation ratio (0 57.69%; =25.62, <0.001). Time from onset was (23±6) days in severe/critical group, significantly longer than that in mild/moderate group [(18±7) days] (=3.40, <0.001). Severe/critical patients had significantly higher crazy-paving pattern ratio (46.15% 10.81%;=4.24, =0.039) and lower ground-glass opacities ratio (15.38% 67.57%; =16.74, <0.001) than the mild/moderate patients. The proportion of lesions in peripheral lung was significantly higher in mild/moderate group than in severe/critical group (78.38% 34.61%; =13.43, <0.001), and the proportion of diffusely distributed lesions was significantly higher in severe/critical group than in mild/moderate group (65.38% 10.81%; =20.47, <0.001). Total CT score in severe/critical group was also significantly higher in severe/critical group than in mild/moderate group [11 (8,17) points 7 (4,9) points; =3.81, <0.001]. The CT features in the recovery stage differ between mild/moderate and severe/critical COVID-19 patients.The lung infiltration is remarkably more severe in the latter.
探讨2019冠状病毒病(COVID-19)康复期轻症/中症及重症/危重症病例的计算机断层扫描(CT)特征。纳入2020年2月1日至2月29日在中国武汉的63例出院患者,这些患者均接受了胸部CT检查及逆转录-聚合酶链反应(RT-PCR)检测。以RT-PCR为金标准,评估胸部CT诊断COVID-19的效能。根据病情将患者分为轻症/中症组和重症/危重症组,收集患者的性别、年龄、症状、住院时间、合并症及氧疗等临床特征。回顾康复期CT图像,观察发病时间、CT特征、病变部位、肺叶评分及CT总分。轻症/中症组37例,重症/危重症组26例。与轻症/中症患者相比,重症/危重症患者年龄更大[(43±16)岁对(52±16)岁;t=2.10,P=0.040],住院时间更长[(15±6)d对(19±7)d;t=2.70,P=0.009],呼吸困难比例更高(5.41%对53.85%;χ2=18.90,P<0.001),鼻导管吸氧比例更低(81.08%对19.23%;χ2=23.66,P<0.001),双水平气道正压通气比例更高(0对57.69%;χ2=25.62,P<0.001)。重症/危重症组发病时间为(23±6)天,显著长于轻症/中症组[(18±7)天](t=3.40,P<0.001)。重症/危重症患者磨玻璃影比例低于轻症/中症患者(15.38%对67.57%;χ2=16.74,P<0.001),铺路石征比例高于轻症/中症患者(46.15%对10.81%;χ2=4.24,P=0.039)。轻症/中症组外周肺病变比例显著高于重症/危重症组(78.38%对34.61%;χ =13.43,P<0.001),重症/危重症组弥漫性分布病变比例显著高于轻症/中症组(65.38%对10.81%;χ2=20.47,P<0.001)。重症/危重症组CT总分也显著高于轻症/中症组[11(8,17)分对7(4,9)分;Z=3.81,P<0.001]。COVID-19康复期轻症/中症与重症/危重症患者的CT特征不同,后者肺部浸润更严重。