新型冠状病毒肺炎患者的临床特点及肺部CT变化模式

Clinical features and change patterns of CT features in the lungs of patients with SARS-CoV-2 pneumonia

目的:回顾性分析新型冠状病毒肺炎(COVID-19)的临床特点、影像学表现和变化模式。方法:对72例确诊为COVID-19患者的流行病学、实验室检查、治疗方案和影像资料进行回顾性分析。其中男、女各36例,年龄16~87岁,平均(53±17)岁。动态观察肺部CT图像上病变类型、分布、累及范围等影像学表现,根据每例患者的肺叶受累平均百分比进行CT半定量评分,总结治疗过程中影像变化的模式和特点。结果:72例中38例(53%)有明确接触史,其中12例(17%)为家庭聚集发病。最常见的症状是发热(51例,占71%)和咳嗽(31例,占43%)。最常见的实验室检查异常是嗜酸细胞计数减少(48例,占67%)和淋巴细胞计数减少(47例,占65%)。最常见的基础病为高血压(17例,占24%)和糖尿病(16例,占22%),有2例(3%)为产妇。最常见的并发症为肝功能异常18例(25%)。46例(64%)例康复出院,25例(35%)仍在住院继续治疗,其中2例(3%)危重患者转入ICU病房,1例(1%)因呼吸衰竭死亡。肺部CT扫描显示双肺下叶最易受累。以CT扫描时间点观察病变高峰期在发病后1~37天,平均(9.92±5.01)天。肺部病变范围CT评分的变化模式可分为5型:进展-高峰-吸收型、进展-高峰-缓慢吸收型、逐渐吸收型、平台型和持续进展型。病变在肺内进展方向有三种模式:沿胸膜下平铺蔓延模式、“摊饼”式和弥漫性。病变密度变化模式主要有2种:磨玻璃影-实变-吸收和逐渐吸收变淡模式。结论:COVID-19患者的肺部CT动态变化有一定的特征,结合临床表现和实验室检查,能够准确评估患者的病情变化,对临床治疗具有指导意义。

Objective:The purpose was to analyze the clinical features,chest CT findings and their change patterns of patients with severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infected pneumonia.Methods:The epidemiological,laboratory and imaging data of 72 patients with COVID-19 were retrospectively analyzed.There were 36 males and 36 females with mean age of(53±17)years(ranged from 16 to 87 years).The types,distribution and involvement scope of pulmonary lesions on CT images were observed dynamically.And the patterns and characteristics of imaging changes were assessed according to the average percentage of lung involvement in each patient with CT semi-quantitative score.Results:At the time of onset of COVID-19,history of exposure was clear in 38 patients(53%)including 12 cases(17%)of familiar clustered infection.The most common symptoms were fever(51%)and cough(31%).The most common positive laboratory tests were decreased eosi-nophil counts(67%)and lymphocyte counts(65%).The most common underlying diseases were hypertension(17,24%)and diabetes(16,22%).In addition,there were 2(3%)cases of parturient women in this study.During the period of isolation,some patients presented abnormal liver function(25%)or renal function(21%).Of the total 72 patients,46(64%)were discharged from hospital,25(35%)were still hospitalized for further treatment,among which 2(3%)patients were transferred to ICU.One patient(1%)died of respiratory failure.Chest CT scan showed that the lower lobes of both lungs were most commonly involved.Starting from the date of CT scan,the peak of the disease evolution was observed on 1~37 days after onset,with an average of(9.92±5.01)days.There were 5 types regarding the range scoring of pulmonary lesion:progress-peak-absorption type,progress-peak-slow absorption type,progress-absorption type,plateau type and continuous progress type,respectively.There were three progression patterns in the lungs:subpleural spreading,focal round spreading and diffuse spreading.There were mainly two change modes of lesion density:ground glass opacity(GGO)-consolidation-absorption and gradual-fading-absorption.Conclusion:The dynamic changes of CT fin-dings in the lungs of patients with COVID-19 have certain characteristics and patterns.Combined with clinical manifestations and laboratory test results,it facilitates the evaluatioon of the changes of patient′s situation and has guiding significance for clinical treatment.