新型冠状病毒肺炎不同时期CT表现及中性粒细胞/淋巴细胞比值、T淋巴细胞亚群变化

CT features of corona virus disease 2019 (COVID-19) in different stages and its correlation with neutrophil-lymphocyte ratio (NLR) and T lymphocyte subsets

目的:探讨新型冠状病毒肺炎(COVID-19)不同时期CT特征及与中性粒细胞/淋巴细胞比值(NLR)、外周血T淋巴细胞亚群的关系,提高对NCP的认识和诊治水平。方法:回顾性分析56例COVID-19患者的CT资料,对其急性期、恢复期(重症期)CT表现进行分析,并对其NLR及T淋巴细胞亚群计数进行对比分析。结果:56例COVID-19中,普通型38例,影像上急性期表现以肺中外带、磨玻璃影为主,恢复期肺内病灶治疗后5例(13.16%)完全吸收,18例(47.37%)明显吸收,15例(39.47%)部分吸收;重型11例,急性期表现为双肺广泛的磨玻璃影和(或)大片状实变影,恢复期明显吸收的7例(63.64%),部分吸收的4例(36.36%);危重型7例,急性期亚实变、实变为主混合磨玻璃影,恢复期明显吸收的1例(14.29%),部分吸收的3例(42.86%),死亡3例,且均为重症期,呈"白肺"改变。普通型组、重型组、危重型组NLR及CD4^+T淋巴细胞计数在急性期、恢复期(重症期)组间差异具有统计学意义(P<0.05)。结论:COVID-19普通型以磨玻璃密度影及斑片状阴影为主,部分实变,重型、危重型以亚实变、实变为主,影像表现多样。治疗后普通型患者多明显吸收,重型、危重型患者多残留间质增生及纤维化。NRL、T淋巴细胞计数对早期识别NCP重型、危重型患者及预后有重要意义。

Objective:The purpose of this study was to investigate the CT features of corona virus disease 2019(COVID-19)in different stages and its correlation with neutrophil-lymphocyte ratio(NLR)and T lymphocyte subsets,so as to improve the understanding and diagnosis of COVID-19.Methods:The CT data of 56 patients with COVID-19 in acute and convalescent stage(severe stage)were analyzed retrospectively.The correlation between the CT features and the NLR and T lymphocyte subsets were analyzed.Results:Among 56 cases of COVID-19,38 cases were common type.The main CT feature of acute stage was ground glass shadows in subpleural areas.5 cases(13.16%)were absorbed completely after treatment in the recovery stage,18 cases(47.37%)were obviously absorbed,15 cases(39.47%)were partially absorbed.For the severe type of 11 cases,CT findings were extensive ground glass opacities and/or large range of consolidation in the acute stage.There were 7 cases(63.64%)with absorption in convalescence stage after treatment,and 4 cases(36.36%)with partially absorption.For the 7 critical severe cases CT presented as mixed ground glass shadows with partial or/and full consolidation in the acute stage.There was one case(14.29%)with obvious absorption in the convalescence stage,and 3 cases(42.86%)with partial absorption.3 cases died,all were in the severe stage and"white lung"sign was showed on CT.The differences of NLR and CD4^+T lymphocyte count between acute stage and convalescence stage(severe stage)were significant(P<0.05).Conclusion:The CT features of common type COVID-19 are mainly GGOs and patchy exudation,some with partial consolidation.While partial or/and full consolidation lesions are mostly shown in the patients of severe and critical severe type.After treatment,the lesions in the lungs of the common type patients are more obviously absorbed than those of the severe and critical severe type patients in which the lesions are various with multiple residual interstitial hyperplasia and fibrosis.The CT features associated with NRL,T lymphocyte count play an important role for early identification of degrees of COVID-19 and its prognosis.