非武汉地区新型冠状病毒肺炎患者初诊CT征象与发病时间的相关性

Relationship between initial CT signs and symptoms onset time in COVID-19 patients outside Wuhan

目的探讨非武汉地区新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者初诊CT征象与发病时间的相关性,识别其早期的变化规律。方法回顾性分析陕西省2020年1月22日至2020年2月10日COVID-19核酸确诊病例的首次胸部CT征象,主要包括肺内磨玻璃样密度(ground glass opacities,GGO)、实变以及GGO合并实变,并对每一位患者肺损伤程度进行评分。随后将CT征象及肺损伤评分与患者发病时间进行相关分析,对数据进行非线性拟合(二次拟合曲线),判断CT征象和评分随发病时间的变化规律。结果91例确诊COVID-19患者共获取293个病灶,其中单纯GGO 143(48.8%)个,GGO合并实变116(39.6%)个,单纯实变34(11.6%)个。非线性拟合分析结果提示,GGO随发病时间有下降趋势,GGO合并实变二次拟合曲线呈正“U”型,实变呈倒“U”型改变,三者约在第7天存在转折点。同时,患者肺损伤评分约在第7天存在峰值。结论非武汉地区COVID-19患者初诊CT表现以GGO和GGO合并实变为主,发病约1周左右可能是CT征象变化的关键时间点。

Objective To explore the correlation between initial chest CT signs and onset time in patients with coronavirus disease 2019(COVID-19)outside Wuhan area and to identify the early changes in chest CT signs.Methods We made a retrospective analysis of the clinical features and CT signs of confirmed cases of COVID-19 in Shaanxi Province from January 22 to February 10,2020.The CT signs were mainly analyzed for ground glass opacities(GGO),consolidation and GGO combined with consolidation in the lung,and the degree of lung injury in each patient was scored at the same time.The correlation of CT signs and lung injury score with onset time was analyzed,and the data were non-linearly fitted(quadratic fitting curve)to judge the changes of CT signs and scores with time.Results A total of 293 lesions were detected in 91 patients with COVID-19,including 143(48.8%)GGO,116(39.6%)GGO with consolidation and 34(11.6%)simple consolidation.The nonlinear fitting analysis revealed that the GGO had a downward trend with the onset time,the quadratic fitting curve of GGO combined with consolidation showed a positive U shape,and the solid change showed an inverted U shape;and the three signs had a turning point on the 7th day.At the same time,the lung injury score of the patients peaked on the 7th day.Conclusion The main CT manifestations of patients with COVID-19 are GGO and GGO combined with consolidation, and the 7th day of onset may be the key time point for the change of CT signs.