甲型H1N1流感肺炎的影像学表现:附34例病例分析

The Chest X-ray and CT Manifestations of Pneumonia Infected with Influenza A(H1N1) Virus:A Report of 34 Cases

目的总结甲型H1N1流感肺炎的X线、CT表现特征。方法对34例临床确诊甲型H1N1流感肺炎患者的X线、CT检查结果进行回顾性分析。结果 34例患者肺部病变X线表现主要为:局部肺纹理增多、增粗、模糊;单侧或双侧肺野片状、斑片状影,密度均匀或欠均匀,边缘清晰或模糊;均未见胸膜反应。34例甲型H1N1流感肺炎病灶共54处,其中右肺野29处(占53.7%),左肺野25处(占46.3%);下肺野有28处(占51.9%),中肺野15处(占27.8%),上肺野11处(占20.3%)。6例行CT检查,5例均表现为两肺多叶、多段片状、大片状实变及毛玻璃样改变,下叶均累及,分布以肺野外侧、后侧为主,均可见空气支气管征。所有病灶内未见空洞、钙化及液化坏死区。均未见纵隔及肺门淋巴结肿大。胸膜极少受累,仅1例见两侧少量胸腔积液。结论甲型H1N1流感肺炎影像学上具有一定的特征性,X线检查是发现H1N1流感肺炎最基本的影像学检查方法,可显示病变密度、形态和范围的动态变化,而CT能更清楚地显示病灶的密度及范围,明确病变的性质,有助于诊断和鉴别诊断。

Objective To study the chest X-ray and CT manifestations of pneumonia infected with influenza A （ H1N1） virus,and to improve the cognition to the disease.Methods The materials the chest X-ray and CT in 34 cases of clinically diagnosed pneumonia infected with influenza A （ H1N1） virus were analyzed retrospectively.Results Radiographic sign of pulmonary lesion with 34 cases：the local lung markings increasing coarsely and fuzzily;Unilateral or bilateral patchy lung field appear the spot laminated shadow,with the density is homogeneous or unhomogeneous,the edge is clear or fuzzy,and no pleural reaction.54 lung markings of 34 cases were involved,with 29 right lung markings（53.7%）and 25 left lung markings （46.3%）,there was no significant difference between the two groups（P0.05）,and with 28 lower lung（51.9%）,15 middle lung（27.8%）,11 upper lung（20.4）,that the morbidity rate of lower lung was the highest Among the three of them〔P（middle-lower）：0.018、P（lower-upper）：0.001〕and there was no significant difference between the other〔P（middle-upper）：0.500〕;CT manifestations with 5 cases of 6 cases examined by CT,were that more than two lobi pulmonis and segment appeared flaky pulmonary consolidation and ground glass opacity,involed in lower lung of all,mainly by outside and rear side,and the air bronchogram was seen in all cases.Cavity,calcification、liquefaction、pattern of hilar and mediastinal lymph nodes was seen in no-one,and pleura was inconvenienced randomly,0nly one with a few bilateral pleural effusions.Conclusion The pneumonia infected with influenza A （ H1N1） virus had a certain chest X-ray and CT characteristics.The chest X-ray indicateing dynamic variation of abnormal density,morphology and range is the the basic Examination for discovering Influenza A （H1N1）,and CT indicating dynamic variation of abnormal density and range more clearly than chest X-ray can definite Properties of lesions and be helpful for diagnosis and differential diagnosis.