非重症新型冠状病毒肺炎的CT和临床特征的演变及相关性

Evolution and correlation of CT imaging signs and clinical features of non-severe COVID-19 patients

目的探讨非重症新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者CT和临床特征的演变规律及相关性。方法以5 d为间隔划分病程,回顾性分析24例非重症COVID-19患者不同时期的胸部CT特征、临床症状和实验室检查的动态变化。临床症状、CT特征等分类变量用率表示,用连续性折线图表示各时期CT特征、临床症状、实验室检查的动态变化。将病变范围CT评分和病灶数目与临床表现进行相关性分析,P<0.05为差异有统计学意义。结果24例非重症COVID-19患者共获取92例动态CT及临床资料:病程0~5 d 12例,5~10 d 21例,10~15 d 22例,15~20 d 20例,>20 d 17例。COVID-19患者的CT主要征象是胸膜下磨玻璃影,伴随征象包括铺路石征、血管增粗、纤维条索影、空气支气管征、小叶中心结节、晕征、反晕征、支气管壁增厚、肺体积缩小;0~5 d,病灶数目最多,急性症状最明显,淋巴细胞计数和淋巴细胞百分比最低,高敏C反应蛋白浓度最高;5~10 d,病变范围CT评分最高,C反应蛋白浓度最高、红细胞沉降率最快,白细胞计数最低。病变范围CT评分和病灶数目与体温、红细胞沉降率、C反应蛋白浓度、高敏C反应蛋白浓度呈正比,与白细胞计数呈反比。结论非重症COVID-19患者0~10 d时的CT和临床特征的变化趋势接近;病变范围CT评分和病灶数目与临床特征呈相关性。

Objective To evaluate the evolution and correlation of CT imaging signs and clinical features of non-severe coronavirus disease 2019(COVID-19).Methods We retrospectively analyzed CT images and clinical features of 24 non-severe COVID-19 patients from the onset at a 5-day interval.We recorded CT image signs,clinical manifestations and laboratory results at each stage,and analyzed their dynamic changes and correlations.Categorical variables were presented by rates.The correlation of the total CT score and the total number of lesions with clinical manifestations was analyzed.P<0.05 indicated statistical significance.Results A total of 92 cases in 24 patients with COVID-19 were analyzed:12 cases in 0-5 days,21 in 5-10 days,22 in 10-15 days,20 in 15-20 days,and 17 in>20 days.The main CT signs of COVID-19 patients were subpleural and ground-glass opacity;the accompanying CT signs included paving stone sign,thickened blood vessels,fibrous cord shadow,air bronchial sign,leaflet center nodule,halo sign,reversed halo sign,bronchial wall thickening,and lung volume shrinking.On days 0-5,the number of lesions was the largest,acute symptoms were the most severe,the lymphocyte count and ratiowere the lowest,and the concentration of high-sensitivity C-reactive protein(H-sCRP)was the highest.On days 5-10,the total CT score,the concentration of C-reactive protein(CRP)and erythrocyte sedimentation rate(ESR)were the highest,and the white blood cell count was the lowest.There were a positive correlation between the CT score and the number of lesions with temperature,ESR,CRP,H-sCRP,and negative correlation with WBC count.Conclusion CT imaging signs were similar to the change of the clinical features on days 0-10.The total CT score and the number of lesions had correlation with the clinical manifestations.