中国医学科学院学报

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中国医学科学院学报

中国医学科学院学报 ›› 2020, Vol. 42 ›› Issue (3): 376-382.doi: 10.3881/j.issn.1000-503X.12588

• 新型冠状病毒肺炎专栏 • 上一篇    下一篇

北京协和医院普通型新型冠状病毒肺炎患者的初诊临床特征及CT影像学表现

宋兰1,宋伟1(),隋昕1,杜铁宽2,刘武1,王百羽1,陆晓平1,徐燕3,杨启文4,曹玮5,金征宇1   

  1. 1 中国医学科学院 北京协和医学院 北京协和医院 放射科
    2 中国医学科学院 北京协和医学院 北京协和医院 急诊科
    3 中国医学科学院 北京协和医学院 北京协和医院 呼吸与危重症医学科
    4 中国医学科学院 北京协和医学院 北京协和医院 检验科
    5 中国医学科学院 北京协和医学院 北京协和医院 感染内科,北京 100730
  • 收稿日期:2020-02-08 出版日期:2020-06-30 发布日期:2020-07-03
  • 通讯作者: 宋伟 E-mail:cjr.songwei@vip.163.com

Preliminary Study on Clinical Features and CT Findings of Common-type Coronavirus Disease 2019 Patients in Peking Union Medical College Hospital

SONG Lan1,SONG Wei1(),SUI Xin1,DU Tiekuan2,LIU Wu1,WANG Baiyu1,LU Xiaoping1,XU Yan3,YANG Qiwen4,CAO Wei5,JIN Zhengyu1   

  1. 1 Department of Radiology
    2 Department of Emergency
    3 Department of Respiratory and Critical Care Medicine
    4 Department of Laboratory
    5 Department of Infectious Diseases,PUMC Hospital,CAMS and PUMC,Beijing 100730,China
  • Received:2020-02-08 Online:2020-06-30 Published:2020-07-03
  • Contact: SONG Wei E-mail:cjr.songwei@vip.163.com

摘要:

目的 初步探讨北京协和医院新型冠状病毒肺炎(COVID-19)初诊患者的临床特征及CT影像学表现。方法 回顾性分析北京协和医院收治的13例2019-nCoV核酸检测阳性的COVID-19患者的流行病学史、临床特征、实验室检查及胸部CT影像学表现,对肺部CT异常病灶的部位、分布、密度及其他伴随征象进行分析,并综合判断患者的临床分型。结果 13例患者临床分型均为普通型,平均年龄为(46.8±14.7)岁(27~68)岁。10例有武汉接触史,2例有近期旅行史,1例有北京郊区出游史。92.3%(12/13)患者白细胞总数正常或降低,15.4%(2/13)患者淋巴细胞数降低。92.3%(12/13)患者发热,11例因发热就诊,2例(15.4%)表现为低热;8例(61.5%)有干咳。13例患者胸部CT均有异常,病变主要沿支气管束及胸膜下分布为主,8例病变相对局限(1~3个肺叶受累)、累及右下叶或左下叶多见,5例为双肺弥漫多发病变。10例(76.9%)患者胸部CT以磨玻璃影表现为主,7例(53.8%)部分磨玻璃影合并局灶实变影,10例(76.9%)病变内见血管束穿行、增粗,12例(92.3%)有支气管壁增厚,10例(76.9%)伴空气支气管征,7例(53.8%)病灶内见散在小透亮影,3例(23.1%)合并细网格影、小叶间隔增厚,2例(15.4%)见反晕征,2例(15.4%)见铺路石征,2例(15.4%)伴胸腔少量积液。结论 本组COVID-19确诊患者多有武汉接触史,初诊症状主要为发热、干咳,白细胞、淋巴细胞水平正常或降低。CT影像学主要表现为沿支气管束分布及胸膜下分布为主的病变,早期呈局限性磨玻璃影,进展期呈双肺多发磨玻璃影及浸润实变影,部分患者病灶内可伴散在透亮影。

关键词: 新型冠状病毒肺炎, 体层摄影术, X线计算机, 影像表现

Abstract:

Objective To summarize the clinical characteristics and chest CT findings of coronavirus disease 2019(COVID-19)patients in Peking Union Medical College Hospital(PUMCH). Methods A total of 13 patients with COVID-19 confirmed at PUMCH from January 20 to February 6,2020 were selected as the research subjects.Their epidemiological histories,clinical characteristics,laboratory tests,and chest CT findings were analyzed retrospectively.The location,distribution,density,and other accompanying signs of abnormal lung CT lesions were recorded,and the clinical types of these patients were assessed. Results The clinical type was “common type” in all these 13 patients aged(46.8±14.7)years(range:27-68 years).Ten patients had a travel history to Wuhan or direct contact with patients from Wuhan,2 cases had recent travel histories,and 1 case had a travel history to Beijing suburb.The white blood cell(WBC)count was normal or decreased in 92.3% of the patients and the lymphocyte count decreased in 15.4% of the patients.Twelve patients(92.3%)had a fever,among whom 11 patients were admitted due to fever and 2 patients(15.4%)had low fever.Eight patients(61.5%)had dry cough.The CT findings in these 13 patients were all abnormal.The lesions were mainly distributed along the bronchi and under the pleura.The lesions were relatively limited in 8 patients(affecting 1-3 lobes,predominantly in the right or left lower lobe),and diffuse multiple lesions of bilateral lungs were seen in 5 patients.The CT findings mainly included ground glass opacities(GGOs)(n=10,76.9%),focal consolidation within GGOs(n=7,53.8%),thickened vascular bundle passing through the lesions(n=10,76.9%),bronchial wall thickening(n=12,92.3%),air bronchogram(n=10,76.9%),vacuole signs in the lesions(n=7,53.8%),fine reticulation and interlobular septal thickening(n=3,23.1%),reversed halo-sign(n=2,15.4%),crazy-paving pattern(n=2,15.4%),and pleural effusion(n=2,15.4%).Conclusions Most of our patients diagnosed with COVID-19 at PUMCH had a travel history to Wuhan or direct contact with patients from Wuhan.The first symptoms of COVID-19 mainly include fever and dry cough,along with normal or reduced counts of WBC and lymphocytes.CT may reveal that the lesions distribute along the bronchi and under the pleura;they are typically localized GGOs in the early stage but can become multiple GGOs and infiltrative consolidation in both lungs in the advanced stage.Scattered vacuole signs may be visible inside the lesions in some patients.

Key words: coronavirus disease 2019, tomography, X-ray computed, imaging features

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