2019冠状病毒病（COVID-19）患者不同疾病阶段胸部CT表现的动态变化：一项多中心研究

Dynamic changes in chest CT findings of patients with coronavirus disease 2019 (COVID-19) in different disease stages: a multicenter study.

作者信息

Huang Yilong, Li Zhipeng, Guo Honglei, Han Dan, Yuan Feng, Xie Ying, Li Zhi, Zhang Jing, Wang Peng, Yang Yan, Li Yudan, Ma Jiyao, Hu Chunzhang, Wang Haolei, Zhao Wei, Yi Wenfang, Peng Yan, Jiang Yuanming, Li Zhanfeng, Yang Duiming, Wu Kaiming, Li Yuchang, Feng Zaihui, Liu Chaohai, Zhu Guangkun, Han Yongyun, He Shaofei, He Bo, Zhang Zhenguang, Pi Jiangyuan

机构信息

Medical Imaging Department, First Affiliated Hospital of Kunming Medical University, Kunming, China.

Medical Imaging Department, Yunnan Provincial Infectious Disease Hospital (Yunnan AIDS Care Center), Kunming, China.

出版信息

Ann Palliat Med. 2021 Jan;10(1):572-583. doi: 10.21037/apm-20-2484.

DOI:10.21037/apm-20-2484

PMID:33545787

Abstract

BACKGROUND

To investigate the dynamic changes in high-resolution computed tomography (HRCT) findings of coronavirus disease 2019 (COVID-19) patients with different severities in different disease stages.

METHODS

We retrospectively collected the clinical and imaging data of 96 patients in Yunnan Province, China, who were diagnosed with COVID-19 between January 22 and March 15, 2020. Based on disease severity, the COVID-19 patients were classified into four types: mild (n=15), moderate (n=59), severe (n=19), and critical (n=3). Based on hospital stay and number of computed tomography (CT) scans, the clinical/disease course was divided into four stages, including stage 1 (days 0-4), stage 2 (days 5-9), stage 3 (days 10-14), and stage 4 (days 15-19). The HRCT findings, CT value, and lesion volume were analyzed for each stage and compared among the four stages of COVID-19 patients.

RESULTS

CT findings were negative over the four stages for all mild COVID-19 patients. More lesions were found in the peripheral lung fields than in peripheral + central fields (P<0.05), and the number of negative patients in stage 4 were more than those in stages 1-3 (P<0.05). The left and right lower lobe were the most frequently affected lobes (P<0.05). In moderate patients, round ground glass opacities (GGOs) decreased from stage 1 to stage 4; partial consolidation peaked in stage 2 and then decreased in stages 3-4; fibrous stripes and subpleural lines increased from stage 1 and peaked in stage 4. Partial consolidation and consolidation were more common in severe patients than in moderate patients over the disease course (P<0.05). Critical patients showed significant partial consolidation and consolidation; The CT value, lesion volume and lesion volume percentage significantly decreased from stages 1-2 to stage 4 (all P<0.05).

CONCLUSIONS

The dynamic changes in lung HRCT images are clinically related to the disease course of COVID-19.

摘要

背景

探讨2019冠状病毒病（COVID-19）不同严重程度患者在不同疾病阶段的高分辨率计算机断层扫描（HRCT）表现的动态变化。

方法

回顾性收集2020年1月22日至3月15日期间在中国云南省确诊为COVID-19的96例患者的临床和影像资料。根据疾病严重程度，将COVID-19患者分为四型：轻型（n = 15）、中型（n = 59）、重型（n = 19）和危重型（n = 3）。根据住院时间和计算机断层扫描（CT）扫描次数，将临床/疾病进程分为四个阶段，包括第1阶段（0 - 4天）、第2阶段（5 - 9天）、第3阶段（10 - 14天）和第4阶段（15 - 19天）。分析每个阶段的HRCT表现、CT值和病变体积，并在COVID-19患者的四个阶段之间进行比较。

结果

所有轻型COVID-19患者在四个阶段的CT表现均为阴性。外周肺野发现的病变比外周 + 中央肺野更多（P < 0.05），第4阶段的阴性患者数量多于第1 - 3阶段（P < 0.05）。左、右下叶是最常受累的肺叶（P < 0.05）。中型患者中，圆形磨玻璃影（GGO）从第1阶段到第4阶段减少；部分实变在第2阶段达到峰值，然后在第3 - 4阶段减少；纤维条索和胸膜下线从第1阶段开始增加，并在第4阶段达到峰值。在整个病程中，重型患者的部分实变和实变比中型患者更常见（P < 0.05）。危重型患者表现出明显的部分实变和实变；CT值、病变体积和病变体积百分比从第1 - 2阶段到第4阶段显著下降（均P < 0.05）。