甲型H1N1流感重症和危重症患者胸部HRCT表现及动态变化

Characteristics of chest HRCT and dynamic changes in severe and critical patients with novel H1N1 influenza A

目的:探讨甲型H1N1流感重症和危重症患者的胸部高分辨率计算机体层X线摄影术(high-resolution computed tomography,HRCT)表现及动态变化,分析其与患者预后的关系。方法:回顾性分析66例甲型H1N1流感重症和危重症患者的临床和影像学资料。所有病例在入院时及入院后分别行HRCT扫描,检查间隔2~16d,平均随访(2.67±1.05)次。结果:66例患者中,男性50例,女性16例;平均年龄(40.42±15.54)岁。HRCT显示病变以两中下肺叶周边胸膜下和支气管旁分布为主。轻度者3例,表现为局灶分布的单纯磨玻璃影;中度者24例,表现为局灶分布的单纯实变影或散在分布的小片实变影合并磨玻璃影;重度者35例,以条片状或大片状实变为主,部分病灶内可见支气管充气征。发病初期进行HRCT检查者病变程度轻,多为磨玻璃影;发病3d以上检查时,病变已有进展;发病7d后,患者肺部均出现多发斑片影,其中磨玻璃影合并实变影者19例、主要呈大片肺实变者10例、合并胸腔积液者16例。入院3d后,病变明显进展者6例、病变范围明显缩小者15例、合并肺间质增生者41例。本组病例多合并胸膜反应,但淋巴结受累数量少、程度轻。结论:甲型H1N1流感重症和危重症患者易合并肺部感染,胸部病变进展迅速,部分患者可出现呼吸衰竭。胸部HRCT检查有助于早期诊断和评估病变,了解病情动态变化,为临床治疗提供帮助。

Objective：To evaluate chest HRCT （high-resolution computed tomography ）characteristics and dynamic changes in patients with novel H1N1 influenza A infection,and briefly analyzes the relationship between the imaging characteristics and clinical prognosis.Methods：Clinical data and imaging findings of 66 cases with confirmed severe and critical H1N1 were analyzed retrospectively.All of the cases received chest HRCT scans in admission to hospital and discharge, scanning interval 2-16 d,average follow-up （2.67±1.05）times.Results：Among the 66 patients,50 cases of male and 16 cases of female,with an average age of （40.42±15.54）years old.The characteristics of chest HRCT findings and dynamic changes were as follows：patchy exudation focus of lung parenchyma was the main finding,while ground glass opacities in 3 cases.The moderate manifestation was pure consolidation focal distribution,or scattered pieces of consolidation and ground glass opacity in 24 cases,which located in the sub-pleural regions.The severe 35 cases manifestated with a large patch of consolidation and there was air bronchogram in the consolidation.Examination in over 3 days showed the progress in pathological changes.Over 7 days after infection,all of lung appear multiple spot piece of shadow;consolidation and ground glass opacity in 19 cases.A large area of consolidation mainly in 10 cases,16 cases of pleural effusion.Three days after admission,the lesions of 6 cases were obvious deterioration,15 cases were significantly reduced,the lesions of lung can be appeared fibrosis between 41 cases.It was common that with pleural reaction,but lymph node involvement was infrequent. Conclusions：There are some radiographic characteristics in novel H1N1 influenza A infection.Severe and critical patients is easily attacked by pulmonary infection,chest disease progression,some people can lead to respiratory failure.Chest imaging examination can play an important role in the early diagnosis.Getting familiar with chest HRCT appearances and dynamic changes is helpful for its early diagnosis and the abnormal changes after medical treatment.