新型冠状病毒肺炎患者的CT表现及动态变化特点

Characteristics of CT Imaging Manifestations and Dynamic Changes in Patients with Novel Coronavirus Pneumonia

目的探讨新型冠状病毒肺炎(COVID-19)患者在不同时期的高分辨率CT(HRCT)影像表现及动态变化特点。方法回顾性分析80例COVID-19患者的CT影像及临床资料,将80例患者按临床分型分为普通组(普通型患者35例)与重症组(重型及危重型患者45例),搜集两组患者的临床资料及发病后首次、病变达高峰期时、出院前末次胸部CT图像并进行对比分析。结果首发临床症状主要为发热(95%)、咳嗽(89%),重症组患者出现胸闷气促、喘气、乏力症状比例高于普通组,差异有统计学意义(P值分别为0.000、0.000、0.026)。实验室检查重症组患者C反应蛋白升高及D二聚体升高比例多于普通组,差异有统计学意义(P值分别为0.031、0.002)。胸部CT表现结果显示早期:多肺叶累及、中外带病变、磨玻璃样密度影(GGO)合并实变影这三种CT表现比例重症组均高于普通组,差异有统计学意义(P值分别为0.001、0.003、0.033)。高峰期:弥漫性病变、大片状实变影、"铺路石征"、粗大条索影、胸腔积液这五种CT表现比例重症组高于普通组,差异有统计学意义(P值分别为0.000、0.000、0.003、0.007、0.008)。吸收期:普通组患者肺内病变在住院后(9.78±2.88)天内明显吸收,出院时大多患者(63%)病变能完全吸收。而重症组患者病变在住院后(13.78±6.08)天后开始吸收,出院时病变以磨玻璃样改变(51%)、肺间质增生(40%)、肺纤维化(69%)为主。结论不同分型、不同时期COVID-19患者的临床表现、实验室检查与影像表现及其动态变存在一定的特异性,CT检查(尤其是HRCT)对该病早期诊断、临床分型、病情监测和判断预后具有重要作用。

Objective To evaluate the HRCT appearances of chest and the dynamic imaging changes of patients with COVID-19 patients in different periods. Methods The CT imaging and clinical data of 80 patients with COVID-19 were retrospectively analyzed and 80 patients were divided into common group(including 35 common patients) and severe group(including 45 severe and critical patients) according to clinical classification. Conducting comparative analysis of the chest CT images for the first time after the patient ’s onset, at the peak of lesions, and before the last discharge. Results The first clinical symptoms were mainly fever(95%) and cough(89%).However, the incidence of chest shortness of breath, wheezing and fatigue in the severe group was higher than that in the common group with statistically significant differences(P= 0.000,0.000,0.026).The proportion of C-reactive protein and D-dimer in patients with severe disease in laboratory examination was higher than that in the common group with statistically significant differences(P=0.031,0.002).The results of chest CT manifestation showed that in the early stage: the three CT performance ratios of multiple pulmonary lobe involvement, middle and outer zone lesions, GGO combined with consolidation, were higher in the severe group than in the common group, with statistically significant differences(P= 0.001,0.033).Peak period: the ratio of five CT manifestations of diffuse lesions, large patchy consolidation, crazy paving sign, grosscord-likeshadows, and pleural effusion were higher in the severe group than in the ordinary group, with statistically significant differences(P=0.000,0.000,0.003,0.007,0.008).Absorptivephase: the pulmonary lesions in the ordinary group were absorbed significantly within(9.78±2.88) d after hospitalization, and most patients(63%) could fully absorb the lesions at discharge.In the severe group, the lesions began to be absorbed after hospitalization(13.78±6.08),and at the time of discharge, the lesions were mainly ground glass-like changes(51%),pulmonary interstitial hyperplasia(40%),and pulmonary fibrosis(69%). Conclusion The clinical manifestations, laboratoryexamination, imaging manifestations and dynamic changes of patients at different classifications and periods have certain specificity.CT examination(especially HRCT) plays an important role in the early diagnosis, clinicalclassification, disease monitoring and prognosis of COVID-19.