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自2019年12月以来,多起原因不明的病毒性肺炎在全世界流行,研究人员通过对下呼吸道样本的深度测序分析,很快确认本次疫情是由一种新型冠状病毒引起的[1-2]。世界卫生组织将这种新型冠状病毒感染引起的疾病命名为新型冠状病毒肺炎(corona virus disease 2019,COVID-19)[3]。COVID-19是一种新型包膜RNA冠状病毒(正冠状病毒亚科沙贝病毒亚属),传染性较强[4]。采用实时聚合酶链反应(real-time polymerase chain reaction, RT-PCR)快速建立了COVID-19特异性病毒核酸检测的方法[5-6],但研究结果表明,CT对COVID-19的诊断灵敏度(97%)高于RT-PCR(30%~60%)[7]。CT可以识别RT-PCR检测结果为阴性但高度怀疑为COVID-19的患者[8-9]。因此,在COVID-19快速传播的过程中,CT在COVID-19的诊断、严重程度判断和控制方面发挥着尤为重要的作用。在COVID-19患者中,多数患者为普通型,因此,我们分析了无锡市第五人民医院收治的50例普通型COVID-19患者的临床和胸部CT表现,以期为COVID-19的鉴别诊治提供理论依据。
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50例COVID-19患者中,男性患者年龄为(39.2±20.9)岁,女性患者年龄为(37.1±18.6)岁。其中,17例患者(34%)曾去过武汉,23例(46%)接触过确诊患者,10例(20%)的暴露史未知。在这些患者中,24例患者(48%)咳嗽,9例(18%)发烧,5例(10%)有乏力症状。其他症状有胸闷、咳痰、咽痛和腹泻。50例患者中有17例(34%)无明显症状。患者的临床表现见表1。
临床表现 患者 (n=50) 暴露史 14 d内有武汉旅居史 17(34) 14 d内有与确诊患者接触史 23(46) 未知 10(20) 症状 发烧 24(48) 咳嗽 9(18) 乏力 5(10) 肌肉痛 1(2) 胸闷 2(4) 咳痰 2(4) 咽痛 1(2) 腹泻 2(4) 无明显症状 17(34) 伴随疾病 高血压 9(18) 糖尿病 2(4) 冠心病 1(2) 癫痫 1(2) 恶性肿瘤 2(4) 十二指肠溃疡 1(2) 精神分裂症 1(2) 手术史 6(12) 表 1 50例普通型新型冠状病毒肺炎患者的临床表现[例(%)]
Table 1. Clinical characteristics of 50 patients with common novel corona virus disease 2019 (case (%))
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大部分普通型患者的实验室检查结果在正常范围内(表2)。2例患者(4%)白细胞减少,13例患者(26%)淋巴细胞计数下降,7例患者(14%)淋巴细胞百分比下降,12例患者(24%)超敏C反应蛋白(hypersensitive C-reactive protein,hs-CRP)水平升高。其他异常包括d-二聚体(18%)、谷丙转氨酶(26%)、天冬氨酸转氨酶(10%)、肌酐(26%)、肌酸激酶(14%)和尿素(8%)水平升高。
项目 患者(n=50) 白细胞计数 升高 0 降低 2(4) 正常 48(96) 淋巴细胞计数 升高 2(4) 降低 13(26) 正常 35(70) 淋巴细胞百分比 升高 5(10) 降低 7(14) 正常 38(76) 超敏C反应蛋白 升高 12(24) 正常 38(76) d-二聚体 升高 9(18) 正常 41(82) 谷丙转氨酶 升高 13(26) 降低 1(2) 正常 36(72) 天冬氨酸转氨酶 升高 5(10) 正常 45(90) 肌酐 升高 13(26) 降低 7(14) 正常 30(60) 肌酸激酶 升高 7(14) 降低 1(2) 正常 42(84) 尿素 升高 4(8) 降低 2(4) 正常 44(88) 表 2 50例普通型新型冠状病毒肺炎患者的实验室检查结果[例(%)]
Table 2. Laboratory test results of 50 patients with common novel corona virus disease 2019 (case (%))
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50例普通型COVID-19患者的CT表现包括肺、支气管及胸膜病变(图1、2)。肺部病变方面,CT示GGO 26例(52%)、实变7例(14%)、铺路石征16例(32%)、空泡征3例(6%)、微血管扩张征3例(6%)、纤维条索7例(14%)、胸膜下线2例(4%)。支气管病变包括空气支气管征3例(6%)、支气管扭曲1例(2%)。胸膜改变有胸膜增厚2例(4%)、胸腔积液1例(2%)。
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由表3可知,从胸部CT所见病灶分布来看,50例患者中32例(64%)以外周为主,4例(8%)外周加中央,其余14例(28%)无病灶,三者间的差异有统计学意义(χ2=24.16,P<0.001),典型病例图见图3。多数患者表现为双侧多叶病变(24例,48%)。左、右肺CT评分差异无统计学意义(χ2=−0.586,P=0.558),下区CT评分高于中、上区(H=6.917,P=0.031),后区CT评分显著高于前区(H=−4.096,P=0.003)。
图 3 1例普通型新型冠状病毒肺炎患者肺部病变分布情况CT图 患者男性,48岁,A示双肺多发病灶累及多叶;B、C示后区病变较严重。CT为计算机体层摄影术
Figure 3. Distribution of pulmonary lesions in 1 patient with common novel corona virus disease 2019
项目 患者
[例(%)]CT 评分
[M(Q1,Q3)]检验值 P值 病灶分布 χ2=24.16 <0.001 无病灶 14(28) − 外周为主 32(64) − 外周加中央为主 4(8) − 累及肺叶 χ2=18.16 <0.001 未累及 14(28) − 单叶 8(16) − 单侧多叶 4(8) − 双侧多叶 24(48) − 左右肺累及 χ2=−0.586 0.558 左侧 32(64) 1(0,2) 右侧 29(58) 1(0,2) 肺的分区 上区 17(34) 0(0,1) H=6.917 0.031 中区 21(42) 0(0,1) 下区 30(60) 1.5(0,2) 前区 16(32) 0(0,1) H=−4.096 0.003 后区 34(68) 1.5(0,3) 注:−表示无此项数据。CT为计算机体层摄影术 表 3 50例普通型新型冠状病毒肺炎患者肺部病变分布及CT评分
Table 3. Distribution and CT score of the pulmonary lesions of 50 patients with common novel corona virus disease 2019
50例普通型新型冠状病毒肺炎患者临床及胸部CT表现的分析
Clinical and chest CT manifestations of 50 patients with common novel corona virus disease 2019
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摘要:
目的 分析50例普通型新型冠状病毒肺炎(COVID-19)患者的流行病学、临床、实验室检测结果及胸部CT表现,为临床诊治提供理论依据。 方法 回顾性分析2020年1至4月于无锡市第五人民医院经实时聚合酶链反应对咽拭子标本检查结果为阳性的50例普通型COVID-19患者[其中,男性26例、女性24例,年龄(38.2±19.6)岁]的临床数据和CT资料;同时对患者行薄层胸部CT扫描多平面重建以观察患者的肺部改变,对各肺区受累情况进行评分。计量资料的比较采用Mann-Whitney U检验。计数资料的比较采用卡方检验。 结果 50例普通型COVID-19患者中,40例患者(80%)曾到过武汉或与确诊患者有过接触史,17例(34%)无明显症状,38例(76%)主要表现为发热、咳嗽、乏力。实验室检查结果多数在正常范围内,部分患者出现淋巴细胞计数下降、超敏C反应蛋白水平升高、淋巴细胞百分比下降。典型CT表现主要为磨玻璃影、铺路石征、实变,且肺组织病变以周围型为主,双侧多叶分布。肺前区CT评分明显低于后区(H=−4.096,P=0.003),中、上区CT评分低于下区(H=6.917,P=0.031)。 结论 普通型COVID-19患者的临床表现可能不明显,实验室检查结果可能无明显异常,而胸部CT的改变比较明显,因此临床诊治过程中应充分结合患者胸部CT的表现,密切关注胸部CT的动态变化。 -
关键词:
- 新型冠状病毒肺炎 /
- 体层摄影术,X线计算机 /
- 临床表现
Abstract:Objectives To analyze the epidemiological, clinical, laboratory test results, and chest CT features of 50 patients with common novel corona virus disease 2019 (COVID-19), so as to provide a theoretical basis for clinical diagnosis and treatment. Methods The clinical manifestations and CT image findings of 50 patients with common novel COVID-19 (including 26 males and 24 females, aged (38.2±19.6) years) who were positive in throat swab samples by real-time polymerase chain reaction in Wuxi Fifth People's Hospital from January to April 2020 were collected and studied retrospectively. In addition, the patients were scanned with thin-layer chest CT and multiplanar reconstruction to observe the changes in their lungs, and the involvement of each lung area was scored. The measurement data were compared by using the Mann-Whitney U test. The Chi-square test was used to compare counting data. Results Of the 50 patients with common novel COVID-19, 40 patients (80%) had been to Wuhan or had a history of contact with confirmed patients, 17 patients (34%) had no evident symptoms, and 38 patients (76%) were primarily characterized by fever, cough and fatigue. The results of laboratory tests are mostly within the normal range, and some patients have shown decreased lymphocyte count, increased level of hypersensitive C-reactive protein, and decreased percentage of lymphocytes. Typical CT manifestations primarily include ground-glass shadow, paving stone sign and consolidation, and lung tissue lesions are primarily of peripheral type, with bilateral lobular distribution. The CT score of the anterior lung area was significantly lower than that of the posterior lung area (H=−4.096, P=0.003), and the CT score of the middle and upper lung area was lower than that of the lower lung area (H=6.917, P=0.031). Conclusions Patients with common novel COVID-19 may not have evident clinical manifestations, and their laboratory results may have no obvious abnormalities, but the change in chest CT is relatively evident. Therefore, patient's chest CT performance and dynamic changes in chest CT should be combined to obtain accurate clinical diagnosis and treatment. -
Key words:
- COVID-19 /
- Tomography, X-ray computed /
- Clinical features
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表 1 50例普通型新型冠状病毒肺炎患者的临床表现[例(%)]
Table 1. Clinical characteristics of 50 patients with common novel corona virus disease 2019 (case (%))
临床表现 患者 (n=50) 暴露史 14 d内有武汉旅居史 17(34) 14 d内有与确诊患者接触史 23(46) 未知 10(20) 症状 发烧 24(48) 咳嗽 9(18) 乏力 5(10) 肌肉痛 1(2) 胸闷 2(4) 咳痰 2(4) 咽痛 1(2) 腹泻 2(4) 无明显症状 17(34) 伴随疾病 高血压 9(18) 糖尿病 2(4) 冠心病 1(2) 癫痫 1(2) 恶性肿瘤 2(4) 十二指肠溃疡 1(2) 精神分裂症 1(2) 手术史 6(12) 表 2 50例普通型新型冠状病毒肺炎患者的实验室检查结果[例(%)]
Table 2. Laboratory test results of 50 patients with common novel corona virus disease 2019 (case (%))
项目 患者(n=50) 白细胞计数 升高 0 降低 2(4) 正常 48(96) 淋巴细胞计数 升高 2(4) 降低 13(26) 正常 35(70) 淋巴细胞百分比 升高 5(10) 降低 7(14) 正常 38(76) 超敏C反应蛋白 升高 12(24) 正常 38(76) d-二聚体 升高 9(18) 正常 41(82) 谷丙转氨酶 升高 13(26) 降低 1(2) 正常 36(72) 天冬氨酸转氨酶 升高 5(10) 正常 45(90) 肌酐 升高 13(26) 降低 7(14) 正常 30(60) 肌酸激酶 升高 7(14) 降低 1(2) 正常 42(84) 尿素 升高 4(8) 降低 2(4) 正常 44(88) 表 3 50例普通型新型冠状病毒肺炎患者肺部病变分布及CT评分
Table 3. Distribution and CT score of the pulmonary lesions of 50 patients with common novel corona virus disease 2019
项目 患者
[例(%)]CT 评分
[M(Q1,Q3)]检验值 P值 病灶分布 χ2=24.16 <0.001 无病灶 14(28) − 外周为主 32(64) − 外周加中央为主 4(8) − 累及肺叶 χ2=18.16 <0.001 未累及 14(28) − 单叶 8(16) − 单侧多叶 4(8) − 双侧多叶 24(48) − 左右肺累及 χ2=−0.586 0.558 左侧 32(64) 1(0,2) 右侧 29(58) 1(0,2) 肺的分区 上区 17(34) 0(0,1) H=6.917 0.031 中区 21(42) 0(0,1) 下区 30(60) 1.5(0,2) 前区 16(32) 0(0,1) H=−4.096 0.003 后区 34(68) 1.5(0,3) 注:−表示无此项数据。CT为计算机体层摄影术 -
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