-
自2019年12月,湖北省武汉市出现多例不明原因的病毒性肺炎,并迅速蔓延至全国及世界其他国家地区,中国疾控预防控制中心迅速介入调查,在感染者的气道上皮细胞中分离出一种新型冠状病毒,世界卫生组织将其命名为2019新型冠状病毒(2019-nCoV),此新型冠状病毒被纳入《中华人民共和国传染病防治法》规定的乙类传染病,并采取甲类传染病的预防和控制措施。2020年2月8日,国家卫生健康委员会将“新型冠状病毒感染的肺炎”暂命名为“新型冠状病毒肺炎”,简称“新冠肺炎”。后WHO将其英文名称修改为“COVID-19”, 国家卫健委与之一致。截至2020年2月9日24时,全国31省(自治区、直辖市)累计报告新冠肺炎确诊病例37 289例,累计死亡病例813例,疑似病例28 942例。此病毒的迅速广泛传播引起了中国乃至世界各国的广泛关注。为了更好地诊治和预防新冠肺炎,现将我院收治的32例新冠肺炎病人的临床表现和肺部影像学特征进行初步总结分析。
-
32例病人中,男性(59.4%)多于女性(40.6%)(约1.5:1)。有明确武汉或武汉人员接触史21例,从暴露到出现临床症状时间1~10 d,平均为4.7 d,无明确武汉旅游或武汉人员接触史11例。绝大部分病人患有肺炎(96.9%),临床主要表现为发热(84.3%)和咳嗽(59.4%),发热以中等热度(38.1~39 ℃)为主(48.1%),低热(37.1~38 ℃)次之(31.2%),高热(39.1~41℃)较少(12.5%);其他临床表现还包括肌肉痛、畏寒、乏力、胸闷气促、头痛、咽痛、流涕,未见腹泻。实验室指标以白细胞计数减少、淋巴细胞计数减少和C反应蛋白增高较为常见(见表 1)。
观察指标 n 百分比/% 性别 男 19 59.4 女 13 40.6 疫区接触史 无疫区接触史 11 34.4 有疫区接触史 21 65.6 临床表现 发热 27 84.3 咳嗽 19 59.4 肺炎 31 96.9 肌肉痛 12 37.5 畏寒 7 21.9 乏力 5 15.6 胸闷气促 4 12.5 头痛 4 12.5 咽痛 2 6.3 流涕 1 3.1 腹泻 0 0 实验室指标 白细胞计数减少 20 62.5 淋巴细胞计数减少 21 65.6 CRP增加 23 71.9 表 1 32例新冠肺炎病人的临床表现
-
32例病人中,两肺发病(81.3%)较单侧发病(18.8%)多见,病灶主要分布于两肺中外带、胸膜下区(96.7%);各肺叶发病频率从高到低依次为左肺下叶、右肺下叶、右肺上叶、右肺中叶及左肺上叶。病灶形态可呈斑片状、结节状、扇形、类圆形及不规则形(见表 2)。
观察指标 n 百分比/% 病灶分布 肺外周、胸膜下 31 96.7 两侧肺 26 81.3 单侧肺 6 18.8 肺叶受累 左上肺 23 71.9 左下肺 29 90.6 右上肺 24 75.0 右下肺 27 84.4 右中肺 24 75.0 病灶形态 斑片状 27 84.6 结节状 8 23.1 扇形 12 36.5 不规则形 15 48.1 HRCT表现 单纯GGO 26 80.3 GGO伴实变 20 62.5 完全实变 14 43.8 结节影 7 21.9 小叶间隔增厚 23 71.9 支气管血管束增粗 22 68.8 铺路石征 14 43.8 空气支气管征 12 37.5 空泡/空腔 9 28.1 晕征 8 25.0 反晕征 6 18.8 树芽征 4 12.5 肺纤维化 6 18.8 白肺 1 3.1 胸腔积液 4 12.5 胸膜增厚 7 21.9 纵膈淋巴结肿大 1 3.1 阴性 1 3.1 表 2 32例新冠肺炎病人的影像学表现
病变早期病人HRCT可表现为小叶性磨玻璃浸润影或实性结节影(21.9%)。临床轻症病人肺部CT表现可呈阴性(3.1%)。进展期病灶以单纯磨玻璃阴影(GGO)常见(80.3%),其次为磨玻璃阴影伴实变(62.5%),完全实变者相对较少(43.8%)。转归期一般出现在发病后1周左右,病变位于肺外周/胸膜下,范围缩小,部分小叶间隔增厚,GGO逐渐消失,实变逐渐消失。重症病人主要呈两肺弥漫性病变,可发展为“白肺”(3.1%),伴有肺纤维化(18.8%)、胸腔积液(12.5%)、胸膜增厚(21.9%)及纵膈淋巴结肿大(3.1%)。其他常见影像学表现还包括小叶间隔增厚(71.9%)、支气管血管束增粗(68.8%)、“铺路石”征(43.8%)、空气支气管征(37.5%)、空泡/空腔(28.1%)、晕征(25%)、反晕征(18.8%)、树芽征(12.5%)(图 1~2、见表 2)。
新型冠状病毒肺炎32例临床表现及影像学特征初探
Clinical and imaging features of 32 cases of coronavirus disease 2019
-
摘要:
目的初步探讨新型冠状病毒肺炎的临床特点与影像学特征。 方法对临床已确诊为新型冠状病毒肺炎病人32例的临床资料和肺部高分辨率CT(HRCT)表现进行回顾性分析,并根据病变范围与类型将病人分为早期、进展期、重症期、转归期,对HRCT表现进行分析。 结果病人中男性多于女性(1.5:1),多数病人有直接或间接的武汉人员接触史,临床以发热(84.3%)、咳嗽(59.4%)为主要表现,白细胞计数减低(62.5%)、淋巴细胞计数减少(65.6%)、C反应蛋白增高(71.9%)较为常见。HRCT表现以两肺发病多见(81.3%),主要分布于两肺中外带、胸膜下区(96.7%),最常见于左肺下叶(90.6%);形态多表现为斑片状(84.6%)和不规则形(76.9%);病灶以单纯磨玻璃影(80.3%)、磨玻璃阴影伴实变(62.5%)较为常见,还可呈完全实变(43.8%)、小叶间隔的增厚(71.9%)、支气管血管束的增粗(68.8%)、“铺路石”征(43.8%)、空泡/空腔影(28.1%)等,重症病人可发展为“白肺”(3.1%)。 结论新型冠状病毒肺炎的临床特点和影像表现具有一定特征性和参考价值,但诊断时仍需结合流行病学、实验室指标等综合考虑。 Abstract:ObjectiveTo investigate the clinical and imaging features of the corona virus disease 2019(COVID-19). MethodsThe clinical data and pulmonary high-resolution CT (HRCT) findings of 32 patients with clinically diagnosed COVID-19 were retrospectively analyzed.According to the range and type of lesions, the patients were divided into early stage, progressive stage, termination stage and severe stage, and their HRCT findings were analyzed. ResultsThere were more male patients than female patients (1.5:1), and most patients had direct or indirect contact history with Wuhan personnel.Fever (84.3%) and cough (59.4%) were the main clinical manifestations, and lower leukocyte count (62.5%), lower lymphocyte count (65.6%) and higher C-reactive protein (71.9%) were common.HRCT findings showed that most lesions were in two lungs (81.3%), which mainly distributed in the middle and outer zone of the two lungs and the subpleural area (96.7%), and most commonly in the left lower lobe (90.6%).Most of the lesions were patchy (84.6%) and irregular (76.9%), the common lesions were ground-glass shadow (80.3%), ground-glass shadow with consolidation (62.5%), complete consolidation (43.8%), thickening of interlobular septum (71.9%), thickening of bronchovascular bundle (68.8%), paving stone sign (43.8%), vacuole/cavity shadow (28.1%) and so on, severe patients could develop "white lung"(3.1%). ConclusionsThe clinical and imaging features of COVID-19 have certain characteristics and reference value, but it still needs to be considered comprehensively in combination with epidemiology and laboratory indicators. -
Key words:
- corona virus disease 2019 /
- clinical feature /
- high-resolution CT
-
表 1 32例新冠肺炎病人的临床表现
观察指标 n 百分比/% 性别 男 19 59.4 女 13 40.6 疫区接触史 无疫区接触史 11 34.4 有疫区接触史 21 65.6 临床表现 发热 27 84.3 咳嗽 19 59.4 肺炎 31 96.9 肌肉痛 12 37.5 畏寒 7 21.9 乏力 5 15.6 胸闷气促 4 12.5 头痛 4 12.5 咽痛 2 6.3 流涕 1 3.1 腹泻 0 0 实验室指标 白细胞计数减少 20 62.5 淋巴细胞计数减少 21 65.6 CRP增加 23 71.9 表 2 32例新冠肺炎病人的影像学表现
观察指标 n 百分比/% 病灶分布 肺外周、胸膜下 31 96.7 两侧肺 26 81.3 单侧肺 6 18.8 肺叶受累 左上肺 23 71.9 左下肺 29 90.6 右上肺 24 75.0 右下肺 27 84.4 右中肺 24 75.0 病灶形态 斑片状 27 84.6 结节状 8 23.1 扇形 12 36.5 不规则形 15 48.1 HRCT表现 单纯GGO 26 80.3 GGO伴实变 20 62.5 完全实变 14 43.8 结节影 7 21.9 小叶间隔增厚 23 71.9 支气管血管束增粗 22 68.8 铺路石征 14 43.8 空气支气管征 12 37.5 空泡/空腔 9 28.1 晕征 8 25.0 反晕征 6 18.8 树芽征 4 12.5 肺纤维化 6 18.8 白肺 1 3.1 胸腔积液 4 12.5 胸膜增厚 7 21.9 纵膈淋巴结肿大 1 3.1 阴性 1 3.1 -
[1] WEISS SR, LEIBOWITZ JL.Coronavirus pathogenesis[J].Adv Virus Res, 2011, 81:85. doi: 10.1016/B978-0-12-385885-6.00009-2 [2] SU S, WONG G, SHI WF, et al.Epidemiology, genetic recombination, and pathogenesis of coronaviruses[J].Trends Microbiol, 2016, 24(6):490. doi: 10.1016/j.tim.2016.03.003 [3] ZHU N, ZHANG D, WANG W, et al.A Novel Coronavirus from Patients with Pneumoniain China, 2019[J].N Engl J Med, 2020, 382(8):1. [4] CHUNG M, BERNHEIM A, MEI X, et al.CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)[J].Radiology, 2020, doi:10.1148/radiol.2020200230. [5] LEE N, HUI D, WU A, et al.A major outbreak of severe acute respiratory syndrome in Hong Kong[J].N Engl J Med, 2003, 348(20):1986. doi: 10.1056/NEJMoa030685 [6] ASSIRI A, AL-TAWFIQ JA, AL-RABEEAH AA, et al.Epidemiological, demographic, and clinical characteristics of 47 cases of Middle East respiratory syndrome coronavirus disease from Saudi Arabia:A descriptive study(Article)[J].Lancet Infect Dis, 2013, 13(9):752. doi: 10.1016/S1473-3099(13)70204-4 [7] HUANG C, WANG Y, LI X, et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China[J].Lancet, 2020, 395(10223):497. doi: 10.1016/S0140-6736(20)30183-5 [8] GUAN WJ, NI ZY, HU Y, et al.Clinical characteristics of 2019 novel coronavirus infection in China[J].MedRxiv, 2020, https://doi.org/10.1101/2020.02.06.20020974. doi: 10.1101/2020.02.06.20020974 [9] CHEN NS, ZHOU M, DONG X, et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China:a descriptive study[J].Lancet, 2020, 395(10223):507. doi: 10.1016/S0140-6736(20)30211-7 [10] LEI J, LI J, LI X, et al.CT Imaging of the 2019 Novel Coronavirus (2019-nCoV) Pneumonia[J].Radiology, 2020, doi:10.1148/radiol.2020200236. [11] SONG FX, SHI NN, SHAN F, et al.Emerging Coronavirus 2019-nCoV Pneumonia[J].Radiology, 2020, doi:10.1148/radiol.2020200274. [12] OOI GC, KHONG PL, MÜLLER NL, et al.Severe Acute Respiratory Syndrome:temporal lung changes at thin-section CT in 30 patients[J].Radiology, 2004, 230(3):836. doi: 10.1148/radiol.2303030853 [13] AJLAN AM, AHYAD RA, et al.Middle East respiratory syndrome coronavirus (MERS-CoV) infection:chest CT findings[J].Am J Roentgenol 2014, 203(4):782. doi: 10.2214/AJR.14.13021 [14] WONG KT, ANTONIO GE, HUI DS, et al.Severe acute respiratory syndrome:radiographic appearances and pattern of progression in 138 patients[J].Radiology 2003, 228(2):401. doi: 10.1148/radiol.2282030593 [15] KOO HJ, LIM S, CHOE J, et al.Radiographic and CT Features of Viral Pneumonia[J].Radiographics, 2018, 38(3):719. doi: 10.1148/rg.2018170048 [16] WANG QL, ZHANG ZY, SHI YX, et al.Emerging H7N9 influenza A (novel reassortant avian-origin) pneumonia:radiologic findings[J].Radiology, 2013, 268(3):882. doi: 10.1148/radiol.13130988 [17] DAS KM, LEE EY, JAWDER SEA, et al.Acute Middle East respiratory syndrome coronavirus:temporal lung changes observed on the chest radiographs of 55 patients[J].Am J Roentgenol, 2015, 205(3):W267. doi: 10.2214/AJR.15.14445