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): 370-375.doi: 10.3881/j.issn.1000-503X.12691

• 新型冠状病毒肺炎专栏 • 上一篇    下一篇

普通型与重/危重型新型冠状病毒肺炎恢复期CT影像对比

邹文彬1,刘常宇1,蔡奕欣1,曾志林2,张霓1,付向宁1()   

  1. 1 华中科技大学同济医学院附属同济医院 胸外科
    2 华中科技大学同济医学院附属同济医院 感染科,武汉 430030
  • 收稿日期:2020-03-06 出版日期:2020-06-30 发布日期:2020-07-03
  • 通讯作者: 付向宁 E-mail:fuxn2006@aliyun.com

Comparison of Recovery Phase CT Features between Mild/moderate and Severe/critical Coronavirus Disease 2019 Patients

ZOU Wenbin1,LIU Changyu1,CAI Yixin1,ZENG Zhilin2,ZHANG Ni1,FU Xiangning1()   

  1. 1 Department of Thoracic Surgery
    2 Department of Infectious Disease,Tongji Hospital,Tongji Medical College, Huazhong University of Science and Technology,Wuhan 430030,China
  • Received:2020-03-06 Online:2020-06-30 Published:2020-07-03
  • Contact: FU Xiangning E-mail:fuxn2006@aliyun.com

摘要:

目的 比较普通型与重/危重型新型冠状病毒肺炎(COVID-19)患者恢复期的CT影像,探讨COVID-19影像学转归特点。方法 回顾性分析2020年2月1日至29日在华中科技大学同济医学院附属同济医院确诊并治愈出院的63例COVID-19患者的临床资料,分为普通型组和重/危重型组,比较恢复期首次CT影像特点,统计临床资料包括年龄、住院时间、性别、就诊症状、合并症、氧疗方式、CT至发病时间、CT特征、病灶分布、肺叶评分和累计CT评分。结果 普通型组纳入37例,重/危重型组纳入26例。与普通型组相比,重/危重型组患者的平均年龄更大[(43±16)岁比(52±16)岁;t=2.10, P=0.040],平均住院时间更长[(15±6)d比(19±7)d;t=2.70, P=0.009],呼吸困难(5.41%比53.85%;χ2=18.90, P<0.001)和无创呼吸机辅助通气比例(0比57.69%;χ2=25.62, P<0.001)更高,经鼻导管吸氧比例更低(81.08%比19.23%;χ2=23.66, P<0.001)。重/危重型组患者纳入CT影像距发病时间平均为(23±6)d,明显长于普通型组的(18±7)d(t=3.40, P<0.001)。普通型组磨玻璃样病变比例明显高于重/危重型组(67.57%比15.38%;χ2=16.74, P<0.001),而重/危重型组铺路石样表现明显高于普通型组(46.15%比21.62%;χ2=4.24, P=0.039);普通型组肺野外周带病灶比例明显高于重/危重型组(78.38%比34.61%;χ2=13.43, P<0.001),重/危重型组弥散性分布病灶比例明显高于普通型组(65.38%比10.81%;χ2=20.47, P<0.001);重/危重型组中位CT评分为11(8,17)分,明显高于普通型组的7(4,9)分(Z=3.81, P<0.001)。结论 不同临床分型COVID-19 出院患者恢复期CT影像存在差异,重/危重型组双肺病灶浸润程度明显重于普通型组,需要更长时间随访以观察重/危重型患者胸部CT最终吸收情况。

关键词: 新型冠状病毒肺炎, 恢复期, 普通型, 重/危重型, CT影像特征

Abstract:

Objective To investigate the computed tomographc(CT)features of mild/moderate and severe/critical cases of coronavirus disease 2019(COVID-19)in the recovery phase. Methods Totally 63 discharged patients in Wuhan,China,who underwent both chest CT and reverse transcription-polymerase chain reaction(RT-PCR)from February 1 to February 29,2020,were included.With RT-PCR as a gold standard,the performance of chest CT in diagnosing COVID-19 was assessed.Patients were divided into mild/moderate and severe/critical groups according to the disease conditions,and clinical features such as sex,age,symptoms,hospital stay,comorbidities,and oxygen therapy were collected.CT images in the recovery phase were reviewed in terms of time from onset,CT features,location of lesions,lobe score,and total CT score. Results There were 37 patients in the mild/moderate group and 26 in the severe/critical group. Compared with the mild/moderate patients,the severe/critical patients had older age [(43±16) years vs. (52±16) years; t=2.10, P=0.040], longer hospital stay [(15±6)d vs. (19±7)d; t=2.70, P=0.009], higher dyspnea ratio (5.41% vs. 53.85%; χ2=18.90, P<0.001), lower nasal oxygen therapy ratio (81.08% vs. 19.23%;χ2=23.66, P<0.001), and higher bi-level positive airway pressure ventilation ratio (0 vs. 57.69%; χ2=25.62, P<0.001). Time from onset was (23±6) days in severe/critical group, significantly longer than that in mild/moderate group [(18±7) days] (t=3.40, P<0.001). Severe/critical patients had significantly higher crazy-paving pattern ratio (46.15% vs.10.81%;χ2=4.24, P=0.039) and lower ground-glass opacities ratio (15.38% vs. 67.57%; χ2=16.74, P<0.001) than the mild/moderate patients. The proportion of lesions in peripheral lung was significantly higher in mild/moderate group than in severe/critical group (78.38% vs.34.61%; χ2=13.43, P<0.001), and the proportion of diffusely distributed lesions was significantly higher in severe/critical group than in mild/moderate group (65.38% vs.10.81%; χ2=20.47, P<0.001). Total CT score in severe/critical group was also significantly higher in severe/critical group than in mild/moderate group [11 (8,17) points vs. 7 (4,9) points; Z=3.81, P<0.001]. Conclusions The CT features in the recovery stage differ between mild/moderate and severe/critical COVID-19 patients.The lung infiltration is remarkably more severe in the latter.

Key words: coronavirus disease 2019, recovery stage, mild/moderate type, severe/critical type, CT features

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