新型冠状病毒肺炎临床表现及高分辨率CT影像演变特征

Clinical features and high resolution CT imaging evolution of coronavirus disease 2019

目的探讨新型冠状病毒肺炎(COVID-19)临床表现及高分辨率CT(HRCT)影像分型和影像演变特征的临床意义。方法回顾性分析2020年1月20日至2月8日武汉大学人民医院确诊的141例COVID-19患者的临床特征、病毒核酸检测结果和HRCT影像学分型及影像演变特征。结果141例COVID-19患者首诊实验室检查发现白细胞计数及淋巴细胞比率降低。141例COVID-19患者中临床表现以发热最为常见(>37.5℃)139例(98.58%),偶见呼吸道以外症状如腹泻4例(2.84%)。141例COVID-19患者HRCT均有异常,52例(36.88%)胸部HRCT图像表现为磨玻璃影(GGO),以胸膜下分布为主;23例(16.31%)GGO合并局灶实变影;27例(19.15%)呈小片状模糊影;20例(14.18%)呈大片状实变影;48例(34.04%)可见支气管血管束增粗和血管穿行征;5例(3.55%)有空气支气管征;7例(4.96%)有小结节影;5例(3.55%)呈纤维化、网格影或条索影。首次核酸检测阳性者135例(95.74%),阴性者6例(4.26%),同期HRCT结果普通型71例(50.35%)、重型47例(33.33%)和危重型23例(16.31%),各型自起病至首次CT检查平均时间分别为(2.51±1.32)、(5.02±2.01)、(5.91±1.76)d;其中首次检查为重型的病例有19例(19/47,40.43%)在第二次检查时病变分型加重、第三次检查时分型减轻。第二次核酸检查阳性者141例(100%),同期HRCT结果为普通型44例(31.21%)、重型53例(37.59%)和危重型44例(31.21%),各型距离首次CT检查平均间隔时间分别为(3.32±1.61)、(3.93±1.84)和(4.15±1.57)d。第三次核酸检查阳性者113例,阴性者28例,同期HRCT结果为普通型79例(56.03%)、重型46例(32.62%)和危重型16例(11.35%),各型距离首次CT检查平均间隔时间分别为:(5.59±1.83)、(7.32±1.37)、(7.55±1.78)d;不同时间节点CT检查影像分型的差异均具有统计学意义(P<0.05)。结论COVID-19的临床特征及HRCT影像表现多样,双肺广泛的GGO、浸润影为其典型表现;病毒核酸检测阳性通常早于或与CT阳性同步出现,核酸检测存在假阴性,在特定的流行病学背景下,CT影像表现和演变特征在肺部损伤早期预警、评估病变严重程度以及帮助临床进行分型和治疗后随访中具有重要意义。

Objective To investigate the clinical manifestations of the clinical characteristics of 141 patients with coronavirus disease 2019(COVID-19)and the imaging evolution characteristics of High Resolution CT(HRCT)in the chest.Methods From January 20,2020 to February 8,141 COVID-19 patients in Renmin Hospital of Wuhan University,77 males and 64 females,with a median age of 49(9,87),were retrospectively analyzed.The clinical features,laboratory examination indexes and HRCT evolution findings of 141 COVID-19 patients were analyzed.Results Laboratory examinations of 141 COVID-19 patients showed a decrease in white blood cell count and lymphocyte ratio.Among the 141 patients with COVID-19,fever(>37.5℃)was the most common clinical manifestation in 139 cases(98.58%),and occasionally non-respiratory symptoms such as diarrhea in 4 cases(2.84%).141 patients with COVID-19 had abnormal HRCT.52(36.88%)chest HRCT images showed ground-glass opacity(GGO),mainly under pleural;23(16.31%)GGO with focal consolidation;27(19.15%)small flaky shadows;20 cases(14.18%)large flaky consolidation shadows;48 cases(34.04%)bronchovascular bundle thickening and vascular penetrating signs;5 cases(3.55%)had air bronchial signs;7 cases(4.96%)of small nodule shadows;5 cases(3.55%)of fibrosis,grid shadows or strand shadows.135 cases(95.74%)were positive for the first time nucleic acid test,6 cases(4.26%)were negative,and 71 cases(50.35%)of common type,47 cases(33.33%)of severe type and 23 cases(16.31%)of critical type were found during the same period.The average time from onset of each type to the first CT examination was:(2.51±1.32),(5.02±2.01),and(5.91±1.76)days;19(19/47,40.43%)of which were severe for the first time CT classification worsened at the second examination and lessened at the third examination.141 cases(100%)were positive for the second nucleic acid test,and the HRCT results for the same period were 44 cases(31.21%)of common type,53 cases(37.59%)of severe type,and 44 cases(31.21%)of critical type;the average interval time was(3.32±1.61),(3.93±1.84),(4.15±1.57)days;the third nucleic acid test were positive among 113 cases and 28 cases were negative,HRCT results of the same period were 79 cases(56.03%)of common type,46 cases(32.62%)of severe type,and 16 cases(11.35%)of critical type;the average interval from the first CT examination were:(5.59±1.83),(7.32±1.37),(7.55±1.78)days.The differences in CT typing at different time were statistically significant(P<0.05).Conclusion The clinical features of COVID-19 and HRCT images are diverse,extensive GGO and infiltrates in both lungs are typical.Viral nucleic acid tests usually occur earlier or at the same time as the CT examination positive,and there are false negatives in nucleic acid tests.In some epidemiological backgrounds,CT imaging manifestations and evolutionary characteristics are of great significance for early warning of lung injury,assessment of disease severity,and assistance in clinical typing and post-treatment follow-up.