12例人感染H7N9禽流感病毒性肺炎的临床影像学分析

The Clinical Imaging Analyses of the Pneumonia of Human Infection with H7N9 Subtype Avian Influenia Virus in 12 Cases

目的探讨人感染H7N9禽流感病毒性肺炎的临床影像学表现及特点。方法收集深圳市第三人民医院2013年12月18日至2014年1月26日收治的12例确诊为人感染H7N9禽流感病毒性肺炎的临床影像学资料(男6例、女6例),对其临床影像学表现进行分析。结果 12例患者均行胸部X线和CT检查。发病早期(≤4d)行影像学检查8例,病变多起始单侧肺下叶,局限于肺叶段分布,其中右肺下叶3例,左肺下叶2例,双肺下叶2例(病变右侧叶偏重1例,左侧偏重1例),3个肺叶1例;主要表现为磨玻璃影和实变影,可见充气支气管征象;伴小叶间隔增厚4例和胸膜腔积液3例。进展期(5-10d):病变迅速进展,累及双肺多叶,呈多发或弥漫性分布,12例均累及3个肺叶以上,其中10例累及5个肺叶,病变仍以起始部位最严重;伴胸膜腔积液11例,心包积液3例,腹膜腔积液1例。吸收期(≥11d):经抗病毒等治疗,病灶开始吸收,但仍残留条索状影、磨玻璃影及片状实变影。结论人感染H7N9禽流感病毒性肺炎,具有早期表现为单侧肺段和肺叶渗出性病变,48-72h内迅速进展为双肺多叶广泛分布的磨玻璃影和实变影的影像学表现特征。伴胸腹腔积液提示病情严重。影像学检查与诊断对本病的临床诊断、疗效评估和预后判断有重要价值。

Objective To investigate the clinical imaging features of the pneumonia of Human Infection with H7N9 subtype Avian-origin Inflnenza Vires..tllredlods The clinical and imaNng data of 12 patients （six men and six women） with H7N9 subtype avian- origin influenza were collected in Shenzhen third peoples hospital since Dec 18,21113 to Jan 26,2014, and the clinical imaging manifestation were analyzed.Results All of the 12 patients underwent X-ray and spiral CT examinations.8 cases of all examinated in its early stage （within 4 days）,The distribution of Lesions were detected in one side of the lower lobe mainly, and limited in the lobe-segment. The lesions located on the right lower lobe in 3 cases ,and left lower lobe in 2 cases, and both lower lobe in 2 cases, three lobes in 1 case respectively. The ground-glass opacities（G（,O） and consolidations in pulmonary segmental or lobar distribution were showed in all cases, Air bronchogram could be found in the consolidations, Pleural effusion was found in 11 cases, The interlobular septal thickening was seen in 4 cases. The bilateral lungs were rapidly involved with nmltiple or ditffuse distribution at the progressive stage （5-10d）.The lung lesions were involved over 3 lobes in all cases. Anmng the total , 5 lobes involved in 10 cases. The most severity of hmg lesions was the primary lobe. Accompany pleural effusion 11 cases and pericardial effusion 3 cases and peritoneal effusion 1 case. Underwent antivirus therapy, the course of disease reached the absorbed period （≥11d）, the lesions began to absorb, at last, the linear, GGO, lamellar shadows remained. Condlusion The H7N9 subtype human avian influenza pneumonia shows some imaging characteristics. The leachability lesions involves unilateral lobe or segnnent on the initial, within 24h-48h the lesion reaches the bilateral lungs ,The imaging findings include GGO and consolidations extensively. Pleural effusion hint that the pathogenetic condition is severe. The imaging examinations and diagnosis play an important role in the clinical diagnosis, therapeutic evaluation, and prognosis Criterion of the disease.