奥密克戎与甲型H1N1病毒性肺炎CT特征对比:初发及随访

Comparison of CT Features of Omicron and Influenza A-H1N1-Associated Viral Pneumonia:Initial Onset and Follow-Up

目的比较新型冠状病毒奥密克戎变异株及甲型H1N1病毒性肺炎的CT影像特征,并探究影响两种肺炎吸收过程的相关因素。资料与方法回顾性收集2022年12月—2023年3月民航总医院奥密克戎病毒性肺炎影响43例(奥密克戎组)和甲型H1N1病毒性肺炎30例(甲流组),对比两组患者的临床资料[年龄、性别、症状(有无发热)、症状持续时间,白细胞、单核细胞、淋巴细胞、中性粒细胞、C反应蛋白等]和初发及随访CT影像学特征[病变密度、分布、征象以及CT严重程度定性评分(CTSS)]。结果奥密克戎组平均年龄高于甲流组[(68.61±15.94)岁比(51.20±16.39)岁,P<0.0001],发热比率(58.1%比86.7%,P=0.009)和单核细胞计数[(0.40±0.16)比(0.58±0.19),P<0.0001]均低于甲流组。胸部CT显示奥密克戎组病灶分布以胸膜下为主,甲流组以胸膜下及沿支气管血管束分布为主(χ^(2)=8.592,P=0.035)。奥密克戎组较甲流组更易出现小叶间隔增厚(χ^(2)=11.753,P=0.001)、铺路石征(χ^(2)=16.216,P<0.0001)、充气支气管征(χ^(2)=16.216,P<0.0001)、胸腔积液(P=0.039)和胸膜增厚(χ^(2)=4.067,P=0.044),而甲流组比奥密克戎组更易出现结节影(χ^(2)=6.971,P=0.008)。奥密克戎组初发(Z=413,P=0.009)及随访CTSS评分(Z=107,P=0.027)均高于甲流组。奥密克戎组随访CTSS差值与初发CTSS相关性最强(r=0.689,P<0.0001)。甲流组随访CTSS差值与症状持续时间相关性最强(r=0.954,P<0.0001)。结论奥密克戎患者初发及随访病变范围均高于甲流患者,奥密克戎患者肺炎吸收程度可能与初发CTSS有关,而甲流患者可能与症状持续时间有关。

Purpose To compare the CT imaging features of the novel coronavirus Omicron variant and influenza A-H1N1-associated viral pneumonia,and to investigate the factors associated with the uptake process of the two pneumonias.Materials and Methods A total of 43 patients with Omicron virus pneumonia(Omicron group)and 30 patients with influenza A(H1N1)virus pneumonia[influenza A(H1N1)group]in Civil Aviation General Hospital from December 2022 to March 2023 were retrospectively collected.The clinical data of the two groups were compared,including age,gender,symptoms(fever or not),duration of symptoms and incidence of complications.White blood cells,monocytes,lymphocytes,neutrophils,C-reactive protein,etc.and initial and follow-up CT imaging features[lesion density,distribution,signs and qualitative CT severity score(CTSS)].Results The mean age of patients in Omicron group was higher versus that in H1N1 group[(68.61±15.94)years vs.(51.20±16.39)years,P<0.0001],and the fever rate in Omicron group(58.1%vs.86.7%,P=0.009)and monocyte count[(0.40±0.16)vs.(0.58±0.19),P<0.0001]were lower than those in the influenza A(H1N1)group.Chest CT showed that the lesions of patients in the Omicron group were mainly distributed under the pleura,and the lesions of patients in the influenza A(H1N1)group were mainly distributed under the pleura and along the bronchovascular bundle(χ^(2)=8.592,P=0.035).Patients in the Omicron group were more likely to have interlobular septal thickening(χ^(2)=11.753,P=0.001),paving pattern(χ^(2)=16.216,P<0.0001),air bronchogram(χ^(2)=16.216,P<0.0001),pleural effusion(P=0.039)and pleural thickening(χ^(2)=4.067,P=0.044)than patients in the influenza A(H1N1)group,while patients in the influenza A(H1N1)group were more likely to have nodules than those in the omicron group(χ^(2)=6.971,P=0.008).The CTSS scores of patients in the omicron group were higher than those in the influenza A(H1N1)group at the initial diagnosis(Z=413,P=0.009)and follow-up(Z=107,P=0.027).The correlation between the change of follow-up CTSS and the initial CTSS in the Omicron group was the strongest(r=0.689,P<0.0001).There was the strongest correlation between the change of follow-up CTSS and the duration of symptoms in influenza A(H1N1)group(r=0.954,P<0.0001).Conclusion Patients in the Omicron group have a higher range of initial and follow-up lesions than those in influenza A(H1N1)group,and the degree of pneumonia absorption in the omicron group may be related to the initial CTSS,whereas in the influenza A(H1N1)group it may be related to the duration of symptoms.