76例新型冠状病毒肺炎患者的临床及CT影像特征分析

Clinical features and CT imaging analysis of 76 patients with Corona Virus Disease 2019

目的:回顾性分析收治的新型冠状病毒肺炎(COVID-19)患者入院首诊的临床特征及CT影像表现特点,旨在为该病的诊断和治疗提供参考.方法:纳入2020年1月末至2020年2月中上旬内在武汉科技大学附属武汉市普仁医院收治的COVID-19确诊和临床诊断的患者76例,均于入院第1天就采集流行病学、胸部CT及血常规等资料.分析患者的临床表现、实验室检查及CT影像特征.结果:核酸检测(RT-PCR)阳性者34例,临床诊断病例42例.轻型及普通型患者64例,重型患者6例,危重型患者6例,其中死亡者3例.临床表现无症状者10例(13.16%),其中无症状者中与确诊为COVID-19患者有接触史者6例(6/10,60%).76例中表现为发热57例(75.00%),咳嗽51例(67.11%),乏力29例(38.16%),胸闷喘气14例(18.42%),肌肉酸痛10例(13.12%),恶心、呕吐及纳差17例(22.37%),咽痛5例(6.58%).76例患者实验室检查主要表现为淋巴细胞比率降低50例(65.79%),白细胞正常60例(78.95%),超敏C反应蛋白升高57例(75.00%),红细胞沉降率升高55例(72.37%),降钙素正常44例(57.89%),降钙素升高32例(42.11%).CT影像表现主要表现为双肺内多发磨玻璃密度影63例(82.89%),伴有混杂密度影34例(44.74%),其中主要分布于胸膜下区者50例(65.79%);病灶合并血管束增粗38例(50.00%),间质增厚57例(75.00%),胸膜增厚40例(52.63%),胸膜平行征30例(39.47%),实变影18例(23.68%),胸膜下线影22例(28.95%),空气支气管征19例(25.00%),胸腔积液5例(6.58%).结论:COVID-19患者CT表现以双肺多发磨玻璃密度影为主,常累及多个叶,以分布于胸膜下区为多,多伴有间质增厚及胸膜增厚,实验室检查主要表现为淋巴细胞降低、白细胞正常,临床表现主要为发热、咳嗽及乏力,值得重视的是有部分最后诊断为COVID-19的患者首次就诊时临床无相关症状,且多数患者与确诊COVID-19患者有密切接触史,对于这类人群应进行实验室、CT检查及核酸检测进行排查.

Objective:To retrospectively analyze the clinical and CT imaging features of the first admission of patients diagnosed as Corona Virus Disease 2019(COVID-19),thus to provide reference for the diagnosis and treatment of the disease.Methods:A total of 76 patients diagnosed by RT-PCT and clinical diagnosis as COVID-19 and admitted by Wuhan Puren Hospital affiliated to Wuhan University of Science and Technology from late January 2020 to early February 2020 were included.Epidemiological data,chest CT and blood routine examination results were collected on the first day of admission.The clinical manifestations,laboratory examinations and CT imaging features of the patients were analyzed.Results:There were 34 cases with nucleic acid test(RT-PCR)positive and 42 cases with clinical diagnosis.Among the 76 patients,64 cases were mild or normal patients,6 cases were severe patients and 6 cases were critical patients with 3 cases died.There were 10 cases(13.16%)with asymptomatic clinical manifestations,of which 6 patients had contact history with confirmed COVID-19 patients(6/10,60%);57 cases(75.00%)of fever,51 cases(67.11%)of cough,29 cases(38.16%)of fatigue,14 cases(18.42%)of chest tightness and wheezing,10 cases(13.12%)of muscle soreness,17 cases(22.37%)of nausea,vomiting and anorexia,5 cases(6.58%)of sore throat.The laboratory tests mainly showed 50 cases(65.79%)of lower lymphocyte ratio,60 cases(78.95%)of normal white blood cell level,57 cases(75.00%)of increased high sensitivity C-reactive protein level,55 cases(72.37%)of enhanced red blood cell sedimentation rate,44 cases(57.89%)of normal calcitonin level and 32 cases(42.11%)of elevated calcitonin level.The main manifestations of CT image demonstrated 63 cases(82.89%)of multiple ground glass density shadow in both lateral lungs and 34 cases(44.74%)with mixed density shadow,of which 50 cases(65.79%)were mainly distributed in subpleural area;38 cases(50.00%)of lesions with thickened vascular bundles,57 cases(75.00%)of interstitial thickening,40 cases(52.63%)of pleural thickening,30 cases(39.47%)of pleural parallel sign,18 cases(23.68%)of consolidation,22 cases(28.95%)of lower pleural shadow,19 cases(25.00%)of air bronchus sign,and 5 cases(6.58%)of pleural effusion.Conclusion:The CT findings of COVID19 patients mainly demonstrate multiple ground glass density shadow,which is often involved in multiple lobes of lung and distributes in subpleural area.There are often accompanied with interstitial and pleural thickening.The laboratory examination mainly shows reduced lymphocytes and normal white blood cell level.The clinical manifestations are mainly fever,cough and fatigue.It is important to be noted that some of the patients confirmed as COVID-19 showed no related symptoms at the first visit,among which most had a history of close contact with the confirmed COVID-19 patients.CT examination and nucleic acid testing should be performed to check out this group of population,