新型冠状病毒Delta变异株危重型患者合并急性鼻窦炎的临床特点及CT表现

CT Findings and Clinical Characteristics of Acute Sinusitis in Critically Ill Patients of SARS-CoV-2 Delta

目的 探讨新型冠状病毒(severeacute respiratory syndrome coronavirus2,SARS-Co V-2)Delta变异株危重型患者合并急性鼻窦炎的临床特点及CT表现。方法采用回顾性研究收集2021年5月21日至2021年7月7日,广州医科大学附属市八医院收治的11例SARS-Co V-2 D e l ta变异株危重型合并急性鼻窦炎患者为研究对象,对其临床特点及鼻窦CT影像资料进行分析。结果 11例SARS-Co V-2Delta变异株感染的危重型患者中,男性7例,女性4例,年龄75(66,85)岁,合并基础疾病100%(11/11),发热100%(11/11),鼻腔黏膜充血水肿100%(11/11),鼻腔内分泌物100%(11/11),鼻窦合并细菌感染72.7%(8/11),合并真菌感染9.1%(1/11),合并细菌及真菌混合感染18.2%(2/11),C-反应蛋白(CRP)117.71(61.08,159.65)mg/L,血清淀粉样蛋白A(SSA)296.48(246.11,306.30)mg/L,白细胞(WBC)10.12(8.35,10.49)×109/L,嗜中性粒细胞(NEU)7.7(5.78,8.27)×109/L,淋巴细胞(LYM)1.00(0.62,1.24)×109/L,降钙素(PCT)0.30(0.23,0.45)ng/m L,白细胞介素-6(IL-6)234.4(176.7,271.41)pg/m L,11例鼻窦炎患者应用鼻-鼻窦炎Lund-Mackay评分标准CT评分为20(17.5,21)分。结论 SARS-Co V-2 Delta变异株危重型合并鼻窦炎的患者均为老年人,鼻窦可以合并细菌、真菌感染,以细菌感染为主,常伴各项炎性指标的升高,以合并基础疾病、发热、鼻腔黏膜充血水肿、鼻腔内分泌物为主要临床表现,副鼻窦CT以窦腔内液性低密度影主要表现,炎性分泌物可阻塞窦口鼻道复合体,当SARS-Co V-2 Delta变异株患者外周血炎性指标明显升高并鼻腔黏膜充血水肿及分泌物时,应及时行鼻窦CT扫描,当CT显示窦腔内液性低密度影时,可提示临床急性鼻窦炎并及时干预治疗,以降低其发展至严重并发症的风险。

Objective To investigate the clinical features and CT manifestations of severe acute respiratory syndrome 2(SARS-Co V-2) Delta variants in critically ill patients with acute sinusitis. Methods A retrospective study was used to collect 11 critically ill patients with acute sinusitis with SARS-Co V-2 Delta variant from May 21,2021 to July 7,2021 in Guangzhou Eighth People’s Hospital,Guangzhou Medical University. The clinical characteristics and CT imaging data of the sinuses were analyzed. Results 11 Among the critically ill patients infected with the SARS-Co V-2 Delta variant strain,7 were males and 4 were females.75(66,85) years old,with underlying diseases 100%(11/11),fever 100%(11/11),nasal mucosal congestion and edema 100%(11/11),nasal secretions 100%(11/11),Sinus combined with bacterial infection 72.7%(8/11),combined with fungal infection 9.1%(1/11),combined with bacterial and fungal mixed infection 18.2%(2/11),C-reactive protein(CRP) 117.71(61.08,159.65) Mg/L,serum amyloid A(SSA) 296.48(246.11,306.30) mg/L,white blood cells(WBC) 10.12(8.35,10.49)×10[9]/L,neutrophils(NEU) 7.7(5.78,8.27)×10[9]/L,lymphocyte(LYM) 1.00(0.62,1.24)×10[9]/L,calcitonin(PCT) 0.30(0.23,0.45)ng/ml,leukocyte-mediated IL-6(IL-6) 234.4(176.7,271.41) pg/ml,11 patients with rhinosinusitis using the rhinosinusitis Lund-Mackay scoring standard CT score of 20(17.5,21) points. Conclusion SARS-Co V-2 Delta variant strain of critically ill patients with sinusitis are all elderly people. Sinuses can be complicated by bacterial and fungal infections,mainly bacterial infections,often accompanied by elevated inflammatory indexes,and combined with underlying diseases The main clinical manifestations are fever,nasal mucosal congestion and edema,and nasal secretions. CT of the paranasal sinuses is mainly manifested by low-density intranasal fluid. Inflammatory secretions can block the sinus-mouth and nasal complex. When SARS-Co V-2 In patients with Delta variant strain,peripheral blood inflammatory indicators are significantly elevated and nasal mucosa congestion,edema,and secretions should be scanned in time for sinus CT scan. When CT shows fluid hypodensity in the sinus cavity,it can prompt clinical acute sinusitis and prompt Intervention treatment to reduce the risk of developing serious complications.