COVID-19治愈期肺纤维化CT量化评分与其急性期PIV、IL-6水平的相关性研究

Correlation Between CT Quantitative Scores of Pulmonary Fibrosis During COVID-19 Cure and PIV and IL-6 Levels in Acute Stage

目的探讨新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者在治愈期的肺纤维化电子计算机断层扫描(computed tomography,CT)量化评分与其急性期肺内炎症体积(pulmonary inflammatory volume,PIV)参数、血清白细胞介素6(interleukin 6,IL-6)水平等因素的相关性。方法收集临床确诊并经住院治愈的COVID-19患者67例(重症病例组34例;普通型病例组33例)。基于患者肺部CT,采用人工智能(AI)软件计算出COVID-19急性期全肺体积(whole lung volume,WLV)、PIV及PIV/WLV比值,对患者治愈期肺纤维化情况进行CT量化评分。采用Spearman秩相关分析比较两组病例出院时肺纤维化CT量化评分与其急性期PIV参数、IL-6的相关性。结果67例COVID-19患者出院时肺纤维化CT表现为磨玻璃影66例(98.51%)、索条影60例(89.55%)、小叶间隔不规则增厚26例(38.81%)、网格影19例(28.36%)、蜂窝或细支气管扩张27例(40.30%),与普通型病例组比较,重症病例组肺纤维化病变更显著。Spearman秩相关分析表明,COVID-19患者治愈期肺纤维CT量化评分与患者年龄、急性期PIV、PIV/MLV、血清IL-6水平呈明显正相关(r值分别为0.359、0.345、0.336、0.413;P均<0.01)。治愈期重症组病例肺纤维化量化评分明显高于普通型病例组(13.90±6.39 vs.9.88±5.93,t=2.697,P=0.009)。结论COVID-19患者治愈期肺纤维化与急性期PIV的大小、血清IL-6升高有显著相关性。重症COVID-19与普通型患者相比纤维化病变范围更广、程度更严重。

Objective To investigate the correlation between the computed tomography(CT)quantitative score of pulmonary fibrosis during healing period of coronavirus disease 2019(COVID-19)and the pulmonary inflammatory volume(PIV)parameters and serum interleukin 6(IL-6)levels in acute phase.Methods A total of 67 patients with COVID-19 who were clinically confirmed and cured by hospitalization were collected(34 cases in the severe case group,33 in the common case group).Based on the patient’s lung CT,artificial intelligence(AI)software was used to calculate the whole lung volume(WLV),pulmonary inflammatory volume(PIV)and PIV/MLV ratio in the acute phase of COVID-19.And the pulmonary fibrosis was scored quantitatively by CT during the cure phase.Spearman rank correlation analysis was used to compare the correlation between the CT quantitative scores of pulmonary fibrosis and PIV parameters in acute phase and IL-6 in the two groups at discharge.Results Among the 67 discharged COVID-19 patients,the CT manifestations of pulmonary fibrosis were ground glass opacity in 66 cases(98.51%),cord shadow in 60 cases(89.55%),lobular septum irregular thickening in 26 cases(38.81%),mesh shadow in 19 cases(28.36%),and honeycomb or bronchiectasis in 27 cases(40.30%).Compared with the common case group,the severe case group had significant changes in pulmonary fibrosis.Spearman rank correlation analysis showed that CT scores of pulmonary fibrosis of COVID-19 patients in the cured stage were positively correlated with age,acute PIV,PIV/WLV,and serum IL-6 levels(r values were 0.359,0.345,0.336,0.413,respectively,all P<0.01).The quantitative scores of pulmonary fibrosis in severe case group during the cure phase were significantly higher than those in common case group(13.90±6.39 vs.9.88±5.93,t=2.697,P=0.009).Conclusion Pulmonary fibrosis in patients with COVID-19 during the cure phase is significantly correlated with the size of PIV and the increase of serum IL-6 at the acute stage.Compared with the common patients of COVID-19,the severe has a wider range and more severe fibrosis.