不同影像学进展模式新型冠状病毒肺炎的临床基线特征分析

Clinical baseline characteristics of COVID-19 with different imaging models

目的:探索不同影像学进展模式新型冠状病毒肺炎(COVID-19)基线资料的差异,为早期识别有重症倾向的患者提供依据。方法:回顾性分析南京市第二医院住院治疗的65例COVID-19的临床资料和影像学特征。以48 h内病变是否出现快速进展分为2组:快速进展型(A组)16例、非快速进展型(B组)49例,分析其基线资料:年龄,性别,潜伏期,临床症状,实验室检查,初次胸部CT的特征(病灶的分布、形态、边界和所累及的肺叶数)。用SPSS 22.0统计软件进行分析,对比2组上述指标存在的差异。结果:2组临床基线资料对比:A组年龄、胸闷症状、基础疾病、乳酸脱氢酶明显高于B组(P值均<0.001);A组CD4、淋巴细胞计数显著低于B组(Z=182.500、259.000,P值均<0.001)。2组影像学基线特征对比:A组多表现为支气管血管束及外周混合性分布的磨玻璃影,病灶的边界模糊;而B组以胸膜下分布边界清楚的磨玻璃影较多见,2组支气管血管束及外周混合性分布、胸膜下外周分布比较差异有统计学意义(χ^2=32.705、13.268,P值均<0.001)。A组中"细网格"征的检出率高于B组(χ^2=4.201,P<0.05)。本研究中反晕征的病例数较少,但A组中有1例早期反晕征表现进展为危重症的患者,值得重视。2组血管影增粗比较,差异无统计学意义(χ^2=1.160,P>0.05)。结论:年龄较大、合并基础疾病、淋巴细胞计数和CD4减低、乳酸脱氢酶升高、病灶沿支气管血管束及外周混合分布、磨玻璃影边界模糊或出现"细网格"征提示病变可能出现快速进展。

Objective To observe the clinical features of different images progress models of the COVID-19,improve the early diagnosis of severe patients.Methods Clinical features and radiological characteristics of the 65 imported COVID-19 patients in Nanjing Second Hospital were retrospectively analyzed.These patients were divided into two groups based on whether the disease progressed rapidly within 48 hours.Groups:rapid progress(group A)16 cases,none rapid progress(group B)49 cases,analysed the basic information,incubation period,clinical characteristics,laboratory and radiological characteristics(include lesions distributions,morphology,borders and numbers of lung lobes involved).SPSS 22.0 statistical software was used to analyze the differences between the two groups.Results Differences in clinical datas between the two groups:the age,chest tightness symptoms,underlying diseases and the level of LDH in group A were significantly higher than those in group B(all P<0.001),the CD4 T lymphocyte and lymphocyte counts in group A were significantly lower than group B(Z=182.500,259.000,both P<0.001).Imaging differences between the two groups:Most of the patients in group A showed a mixed distribution of ground-glass opacity,the boundary of the lesion was blurred,while patients in group B had a clear subpleural distribution boundary,there are significant statistical difference between the two groups(χ^2=32.705,13.268,both P<0.001).The detection rate of"crazy paving"sign in group A was higher than that in group B(χ^2=4.201,P<0.05).The cases of"reversed halo sign"was less and there was no significant difference between the two groups(χ^2=4.201,P>0.05)except one case in group A that a critically case with merit our attentions.Vascular thickening had no statistically significant between the two groups(χ^2=1.160,P>0.05).Conclusions Older patients with underlying disease,decreased lymphocyte count and CD4,elevated LDH,mixed distribution of lesions along the bronchial vascular bundle and periphery,blurred ground-glass opacity boundaries or"crazy paving"sign suggest that the lesion may develop rapidly.