新型冠状病毒肺炎与肺孢子菌肺炎临床及影像学特征的比较

目的探讨新型冠状病毒肺炎(COVID-19)和肺胞子菌肺炎(PCP)患者临床症状及肺部影像的异同点,一方法纳入本院收治的确诊为普通型和重型COVID-19患者97例,艾滋病合并确诊的肺胞子菌肺炎患者40例,收集患者的一般情况、主要症状及肺部CT影像。结果COVID-19组平均年龄(45.24±15.98)岁,大于PCP组的平均年龄(39.48±11.23)岁(P=0.04)。COVID-19组患者男43例(44.33%)、咳嗽53例(54.64%).气促5例(5.15%)均少于PCP组男35例(87.50%),咳嗽37例(92.50%),气促34(85.00%)(P均<0.001).两组患者均发热,肺部影像均有斑片状高密度影、结节影及胸膜增厚特点,两组差异无统计学意义。两组均有磨玻璃样改变,但COVID-19组为点状/斑片状磨玻璃影,而PCP组为弥漫磨玻璃影。COVID-19组胸膜下病变31例(31.96%)多于PCP组1例(2.5%)(P均<0.001).两组肺部影像实变、网格状影、胸腔积液、空洞、钙化、小叶间隔增厚、纵膈淋巴结肿大均少见,且差异无统计学意义(P>0.05).结论COVID-19与PCP临床表现相似。影像学COVID-19主要为点状/斑片状磨玻璃影,以肺外带及胸膜下病变多见,而PCP为以肺门周围及两肺中、下部分布为主的两肺弥漫性磨玻璃影。

Objective To investigate the clinical symptoms and pulmonary imaging features of patients with new coronavirus pneumonia(COVID-19)and pneumosporium pneumonia(PCP).Methods 97 patients with common type and severe COVID-19 were admitted in our hospital,and 40 patients with AIDS combined with confirmed pneumosporium pneumonia.The patient's general condition,main symptoms and lung CT images were collected.Results COVID-19 group,mean age45.24±15.98 age greater than average age in PCP group(39.48±11.23)years(P=0.04).Male COVID-19 group 43 cases(44.33 percent),Cough 53 cases(54.64%)and shortness of breath 5 cases(5.5%)were fewer than PCP men 35 cases(87.50%),37 cases(92.50%)and 34 cases(85.00%)(P<0.001).There was no significant difference between the two groups with fever,patchy high density shadow,nodular shadow and pleural thickening.The two groups had glass-like changes,but the COVID-19 group was dot-like/spotted glass-like,while the PCP group was difRise glass-like.There were 31 cases(31.96%)subpleural lesions in COVID-19 group compared with 1 case(2.5%)in PCP group(P<0.001).solid changes of lung images,mesh shadow,pleural eflusion,cavity,calcification,thickening of lobular septum,and enlargement of mediastinal lymph nodes were rare in the two groups,and the difference was not statistically significant.Conclusion COVID-19 and PCP clinical manifestations are similar.The imaging COVID-19 is mainly punctate/spotted lamellar ground-glass shadow,with significant pulmonary extraluminal and subpleural lesions,while the PCP is diffuse ground-glass shadow of the two lungs mainly distributed around the hilum and in the middle and lower parts of both lungs.