重症COVID-19与甲型H1N1流感肺炎的临床及胸部CT特征对比研究

Comparative study on the clinical and chest CT features of severe COVID-19 and influenza A(H1N1)pneumonia

目的对比重症新型冠状病毒肺炎(corona virus disease 2019,COVID-19)与甲型H1N1流感肺炎的胸部CT影像特征及临床症状、实验室检查结果,以提高对重症COVID-19的影像诊断水平。方法回顾性分析2020年1月至2020年2月我院收治确诊的29例重症COVID-19患者(简称"研究组")的CT表现及临床特点、实验室检查结果,并与2019年1月至2020年2月确诊的58例重症甲型H1N1流感肺炎患者(简称"对照组")进行比较,对比分析两组患者的临床特点、实验室检查结果及CT表现特征。结果研究组发病早期咳嗽及咽痛的阳性率低于对照组,发展到重症的时间长于对照组,差异有统计学意义(P<0.05);研究组的乳酸升高高于对照组,降钙素原、肌红蛋白升高水平低于对照组,差异有统计学意义(P<0.05)。CT影像病灶分布上研究组右肺上叶、中叶的发生率及累及总肺叶数均高于对照组,差异有统计学意义(P<0.05);影像征象上研究组小叶中心结节或树芽征、支气管管壁增厚、纵隔淋巴结肿大及胸腔积液的发生率低于对照组,网格影、小叶内间隔增厚发生率高于对照组,差异有统计学意义(P<0.05)。结论重症COVID-19以双肺弥漫分布的磨玻璃密度影、网格影为主,伴局部实变,小叶内间隔增厚常见,树芽征及小叶中心结节极少见,可合并心包积液及胸腔积液,临床上乳酸水平升高、肌红蛋白正常或轻度升高,与重症甲型H1N1流感肺炎相比,降钙素原正常或轻度升高。

Objective To compare the differences of chest CT imaging,clinical manifestations and laboratory results between severe 2019 coronavirus disease(COVID-19)and H1N1 influenza pneumonia,so as to improve the diagnostic ability of CT imaging for severe COVID-19.Methods The CT findings,clinical manifestations and laboratory results of 29 patients with confirmed severe COVID-19(referred to as"studied group")who admitted to Hospital between January 2020 and February 2020 were retrospectively analyzed,and compared to 58 patients with severe influenza A(H1N1)pneumonia(referred to as"control group")who admitted to Hospital from January 2019 to February 2020 on the clinical manifestations,laboratory results and CT findings.Results The positive rate of cough and sore throat in the early stage of onset in the study group was lower than that in the control group,and the time to severe disease in the study group was longer than that in the control group.The differences were statistically significant(P<0.05).The level of lactic acid in the study group was higher than that in the control group,while the levels of procalcitonin(PCT)and myoglobin in the study group were lower than those in the control group.The differences were statistically significant(P<0.05).On CT images,the incidences of right upper lobe,middle lobe and the total number of involved lobes in the study group were higher than those in the control group.The differences were statistically significant(P<0.05).On imaging signs,the incidences of central lobular nodule or tree-in-bud sign,bronchial wall thickening,mediastinal lymph node enlargement and pleural effusion in the study group was lower than those in the control group,while the incidences of grid shadow and interlobular septal thickening in the study group were higher than that in the control group.The differences were statistically significant(P<0.05).Conclusions Severe COVID-19 was characterized by diffuse ground glass opacity and grid shadow on CT images,accompanied by focal consolidation and atelectasis.Interlobular septal thickening was common,while tree-in-bud sign and centrilobular nodules were rarely observed.Pericardial effusion and pleural effusion can be seen.Clinically,the level of lactic acid was elevated with normal or slightly elevated myoglobin.Compared to severe influenza A(H1N1)pneumonia,PCT level was normal or slightly elevated.