不同分型新型冠状病毒肺炎CT影像定量评分的变化及临床意义

Dynamic changes of chest CT imaging scores in patients with COVID-19 pneumonia

目的探讨新型冠状病毒肺炎(COVID-19)不同临床分型的胸部CT影像定量评分的变化及临床意义。方法回顾性分析2020年1至2月在绍兴市人民医院和绍兴文理学院附属医院经核酸检测确诊的COVID-19患者共32例114次胸部CT图像和临床资料,分析其临床表现、CT检查次数及间隔时间和CT影像定量评分的关系。结果32例确诊患者根据临床分型分为轻型-普通型组21例,重型-危重型组11例。临床表现以发热和呼吸道症状为主,两组患者CT检查间隔时间差异有统计学意义(P=0.04)。轻型及普通型CT影像定量评分在发热第15天达高峰,以后持续下降;重型及危重型CT影像定量评分在发热第12天达高峰,经历缓慢下降平台后小幅上升,发热第24天达第2个小高峰,以后开始持续下降。结论不同COVID-19临床分型患者的CT影像定量评分及其进展时间、演变规律存在差异,可以根据临床分型选择合适的CT检查评估间隔时间,胸部CT影像定量评分对临床采取正确治疗手段及评估恢复情况有很大的参考价值。

Objective To investigate the dynamic changes of chest CT imaging scores in patients with different clinical types of COVID-19.Methods The clinical data and chest CT images of 32 cases of COVID-19 confirmed by nucleic acid test(RT-PCR)in Shaoxing People's Hospital and Affiliated Hospital of Shaoxing University of Arts and Sciences from January to February 2020 were retrospectively analyzed.The clinical manifestations,the number of CT examinations,the interval of CT examinations were documented;and the semi-quantitative scoring system was used for the lesion involvement range in CT images.Results According to clinical classification,32 patients were divided into mild and moderatel group(21 cases)and severe and critical group(11 cases).There was significant difference in interval of CT examinations between two clinical type groups(P=0.04).The results of quantitative scoring and the trend analysis of fever days showed that mild and moderate types reached the peak on 15th day of fever and then declined;while in severe and critical cases,CT quantitative score reached the peak on 12th day of fever,which increased slightly after experiencing a slow decline platform,and reached the second small peak on the 24th day of fever,and then declined.Conclusion There are differences in dynamic changes of imaging scores and progression time between mild and moderate types and severe and critical types of COVID-19 patients.Appropriate interval time of CT examination and assessment can be selected according to clinical types.