新型冠状病毒肺炎确诊与疑似患者的临床和胸部CT影像比较

Comparison of chest CT imaging between confirmed and suspected cases of COVID-19

目的探讨确诊新型冠状病毒肺炎(COVID-19)与疑似COVID-19患者的胸部CT影像征象与临床指标在鉴别诊断中的价值。方法回顾性分析2020年1月21日至2月10日于十堰市太和医院就诊的确诊COVID-19与疑似COVID-19患者的临床及胸部CT影像资料。确诊COVID-19患者105例,疑似COVID-19患者97例。采用χ2检验和两独立样本t检验统计分析二者临床资料和CT征象的差异。结果与疑似COVID-19患者相比,确诊COVID-19平均发病年龄偏高(t=2.460,P=0.01),病变以纯磨玻璃(68例)和混杂磨玻璃密度(53例)为主(χ2=50.016,P<0.01),病灶内易出现间质增厚(83例)(χ2=55.395,P<0.01)、血管增粗(73例)(χ2=57.527,P<0.01),含气支气管征或支气管扩张(67例)(χ2=17.899,P<0.01)、条索灶(54例)(χ2=5.500,P=0.02),易分布在胸膜下且病变长轴与胸膜平行(89例)(χ2=23.597,P<0.01),多无胸腔积液(χ2=7.017,P<0.01);二者病灶形态均以斑片状分布为主(确诊89例,疑似87例)(χ2=19.573,P<0.01)。另外,确诊COVID-19患者短期内病灶多表现为进展(72/87,82.76%),疑似COVID-19患者短期内多表现为缓解(63/89,70.78%),差异具有统计学意义(χ2=51.114,P<0.01)。性别、病灶肺叶分布差异均无统计学意义(χ2=1.462,P=0.23;χ2=7.381,P=0.19)。确诊COVID-19白细胞数(χ2=17.891,P<0.01)、淋巴细胞百分比(χ2=11.151,P<0.01)多表现为正常或减低,肌酸激酶(χ2=9.589,P<0.01)多表现为正常,红细胞沉降率多表现为正常或升高(χ2=4.240,P=0.04)。结论确诊COVID-19影像表现及生化指标具有一定的特征,与疑似COVID-19的CT征象及临床各指标间存在一定差异,对比分析其影像学特征并辅以临床指标、短期复查变化有助于二者的鉴别诊断。

Objective To explore the value of chest CT features and clinical indexes in the differential diagnosis between suspected COVID-19 with two or more negative nucleic acid tests and confirmed COVID-19.Methods The clinical data and chest CT images of 105 cases with confirmed COVID-19(55 males and 50 females,aged from 2 month to 88 years)and 97 cases with suspected COVID-19(59 males and 38 females,aged from 1 month to 93 years)were analyzed retrospectively in Shiyan Taihe Hospital from January 21 to February 10,2020.χ2test and two independent sample t test were used to analyze the clinical data and CT signs of the two group cases,with P<0.05 for statistically significant difference.Results Compared with the suspected patients,the average age of confirmed ones was higher(t=2.460,P=0.01).The main pathological changes were pure ground glass(68 cases)and mixed ground glass density(53 cases)(χ2=50.016,P<0.01).Interstitial thickening(83 cases)(χ2=55.395,P<0.01),vascular widening(73 cases)(χ2=57.527,P<0.01),air bronchogram sign or bronchiectasis(67 cases)(χ2=17.899,P<0.01),fibrous streak shadow(54 cases)(χ2=5.500,P=0.02),commonly distributed under the pleura and the long axis of the lesion was parallel to the pleura(89 cases)(χ2=23.597,P<0.01),most of them had no pleural effusion(χ2=7.017,P<0.01);both lesions were mainly distributed in patches(89 confirmed cases,87 suspected cases)(χ2=19.573,P<0.01).In addition,the lesions of patients with confirmed COVID-19 showed progress in short term(72/87,82.76%),and those with suspected COVID-19 showed remission in short term(63/89,70.78%).The difference was statistically significant(χ2=51.114,P<0.01).There was no significant difference in gender and distribution of pulmonary lobes(χ2=1.462,P=0.23;χ2=7.381,P=0.19).The number of white blood cells(χ2=17.891,P<0.01)and the percentage of lymphocytes(χ2=11.151,P<0.01)of COVID-19 were mostly normal or decreased,creatine kinase(χ2=9.589,P<0.01)was mostly normal,and erythrocyte sedimentation rate was mostly normal or increased(χ2=4.240,P=0.04).Conclusions The imaging features and biochemical indexes of diagnosed COVID-19 are different from those of suspected ones.The comparative analysis of imaging features,clinical indexes and follow up examination are helpful for the differential diagnosis of COVID-19.