重症COVID-19的肺部影像学表现及演变特点分析

Analysis of imaging feature and evolvement characteristic of severe COVID-19

目的探讨重型COVID-19的肺部影像表现及演变特点。方法回顾性分析2020年1月20日至2020年2月20日首都医科大学附属北京佑安医院60例经反转录聚合酶链反应(reverse transcription polymerase chain reaction,RTPCR)确诊的新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者的临床及胸部高分辨率CT(high resolution CT,HRCT)表现。其中男24例、女36例,中位年龄59.5岁。分析短期动态观察中胸部HRCT的演变特点。结果参照新型冠状病毒感染的肺炎诊疗方案(试行第七版)的分组标准,将60例患者分为重症组(29例,48.3%)和轻症组(31例,51.7%)。轻症组的中位年龄(46岁)明显低于重症组(69岁),差异有统计学意义(P<0.05)。重症组的典型HRCT表现为多个肺叶(≥3个肺叶)磨玻璃密度病灶(ground-glass opacities,GGO)48.3%,多个肺叶GGO伴实变(≥3个肺叶)51.7%。轻症组HRCT表现为单侧肺GGO(22.6%),多个肺叶GGO(≥3个肺叶)38.7%,多个肺叶GGO伴实变(≥3个肺叶)12.9%。铺路石征和支气管充气征在重症组分别为17.2%和41.4%,在轻症组为3.2%和9.7%。结论COVID-19的影像表现主要为GGO、铺路石征、GGO伴实变。铺路石和实变提示病变的不同进展状态。HRCT可以为COVID-19的诊断和治疗提供重要依据。

Objective To investigate the characteristic of chest high resolution CT(HRCT)findings of severe coronavirus disease 2019(COVID-19).Methods Retrospective analysis was performed on the clinical and chest CT findings of 60 COVID-19 cases confirmed by RT-PCR in Beijing Youan Hospital between January 20 th and February 20 th 2020.The study included 24 males and 36 females,with median age of 59.5 years old.The evolution characteristics of chest HRCT in shortterm dynamic observation during hospitalization were analyzed.Results Sixty patients were divided into two groups according to the Diagnosis and Treatment Program of 2019 Novel Coronavirus(trial seventh version)of National Health Commission of China.There were 29 cases(48.3%)in severe group including severe and critically severe type and 31 cases(51.7%)in mild group including mild and ordinary type.The median age of mild group was significantly younger than that of severe group(46 vs.69,P<0.05).Typical HRCT findings of the severe group included bilateral pulmonary(≥3 lobes)ground-glass opacities(48.3%)and ground-glass opacities with consolidation(51.7%).HRCT findings of the mild group showed groundglass opacities in unilateral lung(22.6%),bilateral(≥3 lobes)ground-glass opacities(38.7%)and ground-glass opacities with consolidation(12.9%).Crazy-paving sign were 17.2%in the severe group and 3.2%in the mild group,and air bronchogram were 41.4%in the severe group and 9.7%in the mild group,respectively.Conclusions The COVID-19 manifestation is predominantly characterized by ground-glass opacities,crazy-paving sign and ground-glass opacities with consolidation.The crazy-paving sign and consolidation suggest different progressive states of lesions.HRCT provides important bases for diagnosis and treatment of COVID-19.