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新型冠状病毒肺炎患者肺部超声:与胸部计算机断层扫描、呼吸障碍和炎症级联的相关性。

Lung Ultrasound in Patients With SARS-COV-2 Pneumonia: Correlations With Chest Computed Tomography, Respiratory Impairment, and Inflammatory Cascade.

机构信息

Department of Cardiology, Istituto Auxologico Italiano IRCCS, Ospedale S. Luca, Milan.

Dipartimento di Medicina e Chirurgia, Università di Milano-Bicocca, Milan.

出版信息

J Ultrasound Med. 2022 Jun;41(6):1465-1473. doi: 10.1002/jum.15831. Epub 2021 Sep 17.

Abstract

OBJECTIVES

Lung ultrasound (LUS) might be comparable to chest computed tomography (CT) in detecting parenchymal and pleural pathology, and in monitoring interstitial lung disease. We aimed to describe LUS characteristics of patients during the hospitalization for COVID-19 pneumonia, and to compare the extent of lung involvement at LUS and chest-CT with inflammatory response and the severity of respiration impairment.

METHODS

During a 2-week period, we performed LUS and chest CT in hospitalized patients affected by COVID-19 pneumonia. Dosages of high sensitivity C-reactive protein (HS-CRP), d-dimer, and interleukin-6 (IL-6) were also obtained. The index of lung function (P/F ratio) was calculated from the blood gas test. LUS and CT scoring were assessed using previously validated scores.

RESULTS

Twenty-six consecutive patients (3 women) underwent LUS 34 ± 14 days from the early symptoms. Among them, 21 underwent CT on the same day of LUS. A fair association was found between LUS and CT scores (R = 0.45, P = .049), which became stronger if the B-lines score on LUS was not considered (R = 0.57, P = .024). LUS B-lines score correlated with IL-6 levels (R = 0.75, P = .011), and the number of involved lung segments detected by LUS correlated with the P/F ratio (R = 0.60, P = .019) but not with HS-CRP and d-Dimer levels. No correlations were found between CT scores and inflammations markers or P/F.

CONCLUSION

In patients with COVID-19 pneumonia, LUS was correlated with both the extent of the inflammatory response and the P/F ratio.

摘要

目的

肺部超声(LUS)在检测实质和胸膜病变以及监测间质性肺病方面可能与胸部计算机断层扫描(CT)相当。我们旨在描述 COVID-19 肺炎住院患者的 LUS 特征,并比较 LUS 和胸部 CT 显示的肺部受累程度与炎症反应和呼吸损害严重程度的关系。

方法

在两周的时间内,我们对患有 COVID-19 肺炎的住院患者进行了 LUS 和胸部 CT 检查。还获得了高敏 C 反应蛋白(HS-CRP)、D-二聚体和白细胞介素 6(IL-6)的剂量。通过血气试验计算肺功能指数(P/F 比值)。使用先前验证的评分系统评估 LUS 和 CT 评分。

结果

26 例连续患者(3 名女性)在早期症状后 34±14 天接受了 LUS 检查。其中 21 例在同一天进行了 CT 检查。LUS 和 CT 评分之间存在较好的相关性(R=0.45,P=0.049),如果不考虑 LUS 上的 B 线评分,则相关性更强(R=0.57,P=0.024)。LUS B 线评分与 IL-6 水平相关(R=0.75,P=0.011),LUS 检测到的受累肺段数与 P/F 比值相关(R=0.60,P=0.019),但与 HS-CRP 和 D-二聚体水平无关。CT 评分与炎症标志物或 P/F 之间无相关性。

结论

在 COVID-19 肺炎患者中,LUS 与炎症反应的程度和 P/F 比值均相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d2df/8662157/147627beef66/JUM-41-1465-g001.jpg

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