婴幼儿2019冠状病毒病的临床特点及胸部CT表现

Clinical features and chest CT findings of coronavirus disease 2019 in infants and young children

目的探讨婴幼儿2019冠状病毒病(COVID-19)的临床特点及胸部CT表现.方法收集并回顾性分析2020年1月20日至2月10日经核酸检测确诊为COVID-19的婴幼儿(0~3岁)患者的临床资料及胸部CT资料.结果9例患儿均有流行病学史,呈家庭聚集性发病.9例患儿中无症状5例,发热4例,咳嗽2例,流涕1例,均无呼吸系统以外症状.9例患儿实验室检查均未见白细胞及淋巴细胞计数减少,其中6例淋巴细胞计数升高及2例白细胞计数升高.9例患儿中8例CT显示肺部炎症,病灶均位于胸膜下或叶间裂下,3例病灶同时沿支气管血管束分布;病灶形态以结节状(6例)及小斑片状(7例)为主;6例病灶呈磨玻璃影及实变影共存,其中3例可见"晕征",未见典型"铺路石征".结论婴幼儿COVID-19患者临床症状轻,影像学表现不如成人典型,其诊断需结合流行病学史及核酸检测综合判断,胸部CT对于无症状患儿的早期诊断有指导意义.

Objective To study the clinical features and chest CT findings of coronavirus disease 2019(COVID-19)in infants and young children.Methods A retrospective analysis was performed for the clinical data and chest CT images of 9 children,aged 0 to 3 years,who were diagnosed with COVID-19 by nucleic acid detection between January 20 and February 10,2020.Results All 9 children had an epidemiological history,and family clustering was observed for all infected children.Among the 9 children with COVID-19,5 had no symptoms,4 had fever,2 had cough,and 1 had rhinorrhea.There were only symptoms of the respiratory system.Laboratory examination showed no reductions in leukocyte or lymphocyte count.Among the 9 children,6 had an increase in lymphocyte count and 2 had an increase in leukocyte count.CT examination showed that among the 9 children,8 had pulmonary inflammation located below the pleura or near the interlobar fissure and 3 had lesions distributed along the bronchovascular bundles.As for the morphology of the lesions,6 had nodular lesions and 7 had patchy lesions;ground glass opacity with consolidation was observed in 6 children,among whom 3 had halo sign,and there was no typical paving stone sign.Conclusions Infants and young children with COVID-19 tend to have mild clinical symptoms and imaging findings not as typical as those of adults,and therefore,the diagnosis of COVID-19 should be made based on imaging findings along with epidemiological history and nucleic acid detection.Chest CT has guiding significance for the early diagnosis of asymptomatic children.[Chin J Contemp Pediatr,2020,22(3):215-220]