摘要
目的探讨新型冠状病毒肺炎(COVID-19)不同临床分型的临床及影像学表现及CT在早期预测不同临床分型的应用价值。方法回顾性分析2020年1月至2月云南省确诊的143例COVID-19患者的胸部CT平扫图像及临床资料,根据COVID-19诊疗方案(第7版),将所有患者分为轻型(28例)、普通型(92例)、重型(18例)和危重型(5例),并分析其临床特征及CT表现。比较临床分型与CT表现(病变分布、密度、范围、形态、内部/周围特征、周围血管改变等)间的相关性及各影像特征的预测效能。结果临床表现以发热(60/143,41.9%)、咳嗽(57/143,39.9%)症状为主,重型患者更易出现高热表现。重型和危重型患者更常见于老年患者。危重型患者淋巴细胞总数减低[(0.6±0.2)×10^(9)/L]个。除轻型患者外,6例患者CT首诊未见明显异常,余109例中,重型(10.8±4.9)个和危重型(10.8±6.4)个患者首次CT检查肺段累及数目较普通型(5.8±4.6)个多(P<0.001)。病灶形态为楔形病灶(59/109,54.1%)、榕树冠征(35/109,32.1%)、病变内/周围出现血管增粗(87/109,79.8%)、血管集束征(65/109,59.6%)在重型和危重型患者出现概率较高(P<0.05)。各型患者中病变数目、病变密度、病变形态(类圆形、不规则形),病变内部/周围特征(铺路石征、晕征、支气管扩张)并未显示差异有统计学意义(P>0.05)。肺段受累数目及出现楔形病变、榕树冠征有较好的预测效能,AUC分别为0.769、0.759、0.697,血管增粗及血管集束征预测效能稍低,AUC分别为0.626,0.667。多指标联合,其预测效能进一步提高,AUC为0.854。结论CT不仅在COVID-19的早期诊断起到至关重要的作用,同时能够对患者病情的严重程度及预后进行评估。
Objective To investigate the clinical and CT image characteristics of COVID-19 pneumonia,and the predictive value of CT in the early stage of different clinical types.Methods Chest CT and clinical data of confirmed 143 patients with COVID-19 pneumonia in January to February 2020 were enrolled.According to the diagnosis and treatment of COVID-19 pneumonia(trial version 7),all the patients were classified into the mild(n=28),common(n=92),severe(n=36),and critical(n=5)type,and their clinical findings and CT findings were analyzed.CT features included lesions'distribution,density,extension,shape,interior/periphery features,vascular changes.Then the prediction performance of image features were analyzed.Results The main clinical manifestations were fever(60/143,41.9%)and cough(57/143,39.9%).High fever was more common seen in severe patients.Severe and critical types were more common in elderly patients.And the total number of lymphocytes reduced(0.6±0.2×10^9/L)in critical patients.Except for mild patients,there were 6 cases without the obvious abnormality in the first CT diagnosis.In the remaining 109 cases,the number of pulmonary segments involved in the first CT examination of severe patients was significantly higher than that of common patients(5.88±6)(P<0.001).Severe and critical COVID-19 showed wedge-shape(59/109,54.1%)or Ficus crown sign(35/109,32.1%)lesions more frequently than in common COVID-19 and the thickening of blood vessels(87/109,79.8%)and vascular clustering signs(65/109,59.6%)in/around the lesions were more likely to occur in severe and critical types(P<0.05).There was no significant difference in the number of lesions,lesion density,lesion morphology(round,irregular)and internal/peripheral features of the lesion(crazy-paving sign,halo sign,bronchiectasis)(P>0.05).Area under the curve(AUC)of the number of involved lung segments,wedge-shape and Ficus crown sign(AUC:0.769,0.759,0.697,respectively)were higher compared with that of thickening of blood vessels and vascular clustering signs(AUC:0.626,0.
作者
杨云辉
何波
游顶云
杨俊涛
高茜
YANG Yun-hui;HE Bo;YOU Ding-yun;YANG Jun-tao;GAO Qian(Dept.of Medical Imaging,The People’s Hospital of Xishuangbanna Dai Autonomous Prefecture,Xishuangbanna Yunnan 666100;Dept.of Medical Imaging,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;School of Public Health,Kunming Medical University,Kunming Yunnan 650500;Dept.of Radiology,The People’s Hospital of Dali Bai Autonomous Prefecture,Dali Yunnan 671000,China)
出处
《昆明医科大学学报》
CAS
2021年第5期131-137,共7页
Journal of Kunming Medical University
基金
云南省社会发展专项基金资助项目(2020003AC100004)。
