COVID-19患者胸部CT变化规律及转归

Changing regularity and prognosis of Chest CT of COVID-19 patient

目的探讨临床普通型COVID-19患者病程中胸部CT表现的变化规律及最终转归。方法选择临床普通型COVID-19患者33例,其中男性17例,女性16例,年龄18~74岁(48.60±11.85岁)。住院期间主要采用抗病毒治疗和相关基础疾病对症治疗,根据病情变化,间隔2~10 d复查胸部CT,出院14 d后再次复查。收集患者的临床及影像学资料,主要观察病变的位置、数目、形态、密度及有无胸膜增厚、胸腔积液等征象,并统计首诊、历次复查的病灶特征和间隔时间,分析病程中病变的CT动态变化规律及转归与时间相关性。结果首诊时3例CT显示阴性,其余30例中75.8%为双肺多发磨玻璃影,45.5%伴有亚实变或实变,病灶主要位于胸膜下。33例患者在住院期间进行了1~4次复查,21例在病程中病变出现加重或此消彼长现象,最终均明显吸收。17例出院后复查病灶完全吸收,10例有少量残留,其中60%合并基础病,另有6例暂未复查。33例患者在出现症状或核酸检测为阳性后15.79±3.79 d进入恢复期,17例完全吸收患者恢复期为21.70±5.61 d,总病程37.89±7.15 d。结论临床普通型COVID-19预后良好,影像表现的动态变化及与时间相关性具有一定规律,对指导临床治疗有一定价值。

Objective To explore the changes and final outcome of chest CT in patients with common COVID-19 during the course of disease.Methods Thirty-three patients with clinical common COVID-19 were mainly treated with antiviral therapy and symptomatic treatment of related basic diseases during hospitalization,including 17 males and 16 females,with the age from 18 to 74 years old(48.60±11.85 years old).According to the changes of condition,the patients were reexamined by chest CT,at intervals of 2 to 10 days and 14 days after discharge.The clinical and imaging data of the patients were collected.The location,number,shape and density of the lesions and the signs of pleural thickening and pleural effusion were observed.The characteristics and interval time of the first diagnosis and reexamination were counted.The dynamic changes of CT and the correlation between prognosis and time were analyzed.Results At first diagnosis,3 cases showed negative CT.In other 30 cases,75.8%showed multiple ground glass shadow in both lungs,and 45.5%were accompanied with subconsolidation or consolidation.The lesions were mainly located under the pleura.Thirty-three patients were reexamined for 1-4 times during hospitalization,and 21 cases showed aggravation or decline in the course of the disease.All of them were obviously absorbed.After discharge,17 cases were completely absorbed,10 cases had a small amount of residue,60%of them were complicated with underlying diseases,and 6 cases had not been reexamined so far.Thirty-three patients entered the recovery stage after the onset of symptoms or nucleic acid test positive 15.79±3.79 days.The recovery period of 17 patients with complete absorption were 21.70±5.61 days,and the total course of disease were 37.89±7.15 days.Conclusion The prognosis of clinical common type COVID-19 is good.The dynamic changes of imaging manifestations and their correlation with time have a certain rule,which has a certain value in guiding clinical treatment.