From the Departments of Medicine (J.J.S.) and Radiology (D.A.L.), National Jewish Health, 1400 Jackson St, Denver, CO 80205; Division of Pulmonary, Sleep and Critical Care Medicine, Department of Medicine (B.H., R.C.), and Department of Radiology (J.P.K.), NYU Langone Health, NYU Grossman School of Medicine, New York, NY.
Radiology. 2021 Nov;301(2):E383-E395. doi: 10.1148/radiol.2021211396. Epub 2021 Aug 10.
The acute course of COVID-19 is variable and ranges from asymptomatic infection to fulminant respiratory failure. Patients recovering from COVID-19 can have persistent symptoms and CT abnormalities of variable severity. At 3 months after acute infection, a subset of patients will have CT abnormalities that include ground-glass opacity (GGO) and subpleural bands with concomitant pulmonary function abnormalities. At 6 months after acute infection, some patients have persistent CT changes to include the resolution of GGOs seen in the early recovery phase and the persistence or development of changes suggestive of fibrosis, such as reticulation with or without parenchymal distortion. The etiology of lung disease after COVID-19 may be a sequela of prolonged mechanical ventilation, COVID-19-induced acute respiratory distress syndrome (ARDS), or direct injury from the virus. Predictors of lung disease after COVID-19 include need for intensive care unit admission, mechanical ventilation, higher inflammatory markers, longer hospital stay, and a diagnosis of ARDS. Treatments of lung disease after COVID-19 are being investigated, including the potential of antifibrotic agents for prevention of lung fibrosis after COVID-19. Future research is needed to determine the long-term persistence of lung disease after COVID-19, its impact on patients, and methods to either prevent or treat it. © RSNA, 2021.
COVID-19 的急性病程多变,从无症状感染到暴发性呼吸衰竭不等。从 COVID-19 中康复的患者可能会持续出现症状和严重程度不同的 CT 异常。在急性感染后 3 个月,一部分患者会出现 CT 异常,包括磨玻璃影(GGO)和胸膜下带,同时伴有肺功能异常。在急性感染后 6 个月,一些患者的 CT 变化持续存在,包括早期恢复阶段出现的 GGO 消退,以及提示纤维化的改变,如伴或不伴实质变形的网状影。COVID-19 后的肺部疾病的病因可能是长时间机械通气、COVID-19 诱导的急性呼吸窘迫综合征(ARDS)或病毒的直接损伤的后遗症。COVID-19 后肺部疾病的预测因素包括需要入住重症监护病房、机械通气、更高的炎症标志物、更长的住院时间和 ARDS 的诊断。COVID-19 后肺部疾病的治疗方法正在研究中,包括使用抗纤维化药物预防 COVID-19 后肺纤维化。需要进一步的研究来确定 COVID-19 后肺部疾病的长期持续性、对患者的影响以及预防或治疗肺部疾病的方法。©RSNA,2021 年。