高致病性H5N1亚型人禽流感病毒性肺炎的影像学表现特点

Imaging features of pneumonia caused by highly pathogenic H5N1 Subtype human avian influenza virus

目的探讨高致病性H5N1亚型人禽流感病毒性肺炎的影像学检查方法及胸部X线与CT影像表现特点。方法回顾性分析2006年6月深圳接诊的首例由卫生部确诊,并经过抢救治疗痊愈的高致病性H5N1亚型人禽流感病毒性肺炎患者的相关临床及影像学资料。结果胸部影像学特点是:①磨玻璃样影、大小片状影及肺实变影是人禽流感病毒性肺炎较早出现的影像表现;②病灶侵犯肺组织广泛,表现为多叶多段的两肺广泛受累;③病灶蔓延变化迅速;④肺实质、肺间质及胸膜受累可同时存在;⑤病灶吸收慢、迁延时间长,恢复期有肺纤维化的影像表现。结论影像学检查与诊断仍然是人禽流感病毒性肺炎的临床诊断、鉴别诊断、疗效评价及预后分析的重要手段。动态观察人禽流感病毒性肺炎的影像学变化及影像学表现特点,监测ARDS和肺部继发感染等并发症的发生,利于指导临床及时有效地进行治疗。

Objective Explore imaging examination methods for cases with pneumonia caused by highly pathogenic H5N1 subtype human cases of avian influenza virus and the imaging features in chest X-ray and CT. Methods A retrospective analysis of the relevant clinical and imaging materials of the first case with pneumonia caused by highly pathogenic H5N1 subtype human avian influenza virus with diagnosis confirmed by the ministry of health being cured after rescuing. Results The imaging features of the chest were： ①presence of ground-glass like shadows and big and small-sized flaky shadows as well as parenchyma changes in lungs were the imaging manifestations early in this disease of pneumonia caused by highly pathogenic H5N1 Subtype human avian influenza virus. ②There was an extensive invasion of the lung tissues shown by an extensive involvement of multiple lobes and segments of both lungs. ③Rapid spreading and variations of the pathologic focuses. ④There was co-existence of involvement of the pulmonary parenchyma, interstitial tissues and pleura.⑤Absorption of the disease focuses with prolongation in time; there were such changes in imaging manifestations as pulmonary fibrosis. Conclusion Imaging examination and diagnosis remain to be the important measures for making clinical diagnosis; differential diagnosis, evaluation of therapeutic effects as well as prognostic analysis of cases suffering from pneumonia caused by human avian influenza virus. Dynamic observation on imaging changes and imaging features of the pneumonia as well as monitoring occurrence of complications such as ARDS and secondary pulmonary infections, therefore it is beneficial to guide the clinicians to give prompt and effective treatment to the patient.