ISSN 1004-4140
CN 11-3017/P

胸部薄层CT平扫对于重型新型冠状病毒感染的诊断价值

郝琪, 刘晓燕, 张妍, 李兴鹏, 张怡梦, 刘梦珂, 张晓杰, 李玲, 郭佳, 杜常月, 孙莹, 霍萌, 张明霞, 刘薇, 段永利, 段淑红, 王仁贵

郝琪, 刘晓燕, 张妍, 等. 胸部薄层CT平扫对于重型新型冠状病毒感染的诊断价值[J]. CT理论与应用研究, 2023, 32(5): 675-683. DOI: 10.15953/j.ctta.2023.041.
引用本文: 郝琪, 刘晓燕, 张妍, 等. 胸部薄层CT平扫对于重型新型冠状病毒感染的诊断价值[J]. CT理论与应用研究, 2023, 32(5): 675-683. DOI: 10.15953/j.ctta.2023.041.
HAO Q, LIU X Y, ZHANG Y, et al. The Clinical Value of Thin-section Chest Computed Tomography Scan for the Classification of Coronavirus Disease 2019 (COVID-19)[J]. CT Theory and Applications, 2023, 32(5): 675-683. DOI: 10.15953/j.ctta.2023.041. (in Chinese).
Citation: HAO Q, LIU X Y, ZHANG Y, et al. The Clinical Value of Thin-section Chest Computed Tomography Scan for the Classification of Coronavirus Disease 2019 (COVID-19)[J]. CT Theory and Applications, 2023, 32(5): 675-683. DOI: 10.15953/j.ctta.2023.041. (in Chinese).

胸部薄层CT平扫对于重型新型冠状病毒感染的诊断价值

详细信息
    作者简介:

    郝琪: 女,北京大学医学部博士研究生在读,主要研究方向为淋巴管系统疾病影像诊断,E-mail:haoqi0703@163.com

    通讯作者:

    王仁贵: 男,医学博士,北京大学第九临床医学院/首都医科大学附属北京世纪坛医院放射科主任、主任医师,主要研究方向为胸部影像诊断,E-mail:wangrg@bjsjth.cn

  • 中图分类号: R  814;R  563.1

The Clinical Value of Thin-section Chest Computed Tomography Scan for the Classification of Coronavirus Disease 2019 (COVID-19)

  • 摘要: 目的:探讨胸部薄层CT平扫在新型冠状病毒感染(COVID-19)分型中的临床价值。方法:回顾性分析2022年12月20日至2022年12月31日于我院感染科诊断为COVID-19的134例患者,所有患者均行胸部薄层CT平扫检查,并具有完整的临床资料。根据临床分型将患者分为非重症组和重症组,对比分析两组患者的临床资料和肺部影像学特征并进行统计学分析。结果:两组间合并糖尿病的差异具有统计学意义,且重症组(45.8%)合并糖尿病的发生率高于非重症组(25.5%);两组间性别、年龄、平均病程及临床症状的差异均无统计学意义;两组之间病变数量、对称性分布、周围为主分布、弥漫分布、边缘模糊、大片状、束带状、血管束增厚、铺路石征、拱廊征以及煎蛋征的差异有统计学意义;重症组的病灶数量>10个、弥漫分布、大片状、束带状、血管束增厚、铺路石征、拱廊征的发生率高于非重症组,而非重症组的周围为主分布、边缘模糊以及煎蛋征的发生率高于重症组。结论:胸部薄层CT平扫能够明确新冠患者肺部异常影像学表现,评估病变的数量、分布范围及形态特点,合并基础病、病变数量、分布特点、边缘模糊、大片状、束带状、血管束增厚及铺路石征、拱廊征、煎蛋征等特殊征象能有效提示COVID-19分型,为COVID-19的诊治提供更多影像依据。
    Abstract: Objective: To investigate the clinical value of thin-section chest computed tomography (CT) in the typing of coronavirus disease 2019 (COVID-19). Methods: A retrospective analysis was performed on 134 patients diagnosed with COVID-19 in our hospital’s Department of Infectious Diseases from December 20, 2022, to December 31, 2022. All patients underwent thin-section chest CT scan with complete clinical data. According to clinical classification, patients were divided into the non-severe and severe groups. Clinical data and imaging features of the two groups were compared and analyzed, and statistical analysis was conducted. Results: There was a statistically significant difference with respect to diabetes mellitus between the two groups, and the incidence of diabetes mellitus in the severe group (45.8%) was higher than that in the non-severe group (25.5%); There were no significant differences in sex, age, average course of disease, and clinical symptoms between the two groups; There were significant differences in the number of lesions, symmetrical distribution, predominant peripheral distribution, diffuse distribution, blurred edge, morphology of large flake and band, vascular bundle thickening, paving stone sign, arcade sign, and fried egg sign between the two groups, the number of lesions >10, diffuse distribution, morphology of large flake and band, vascular bundle thickening, paving stone sign, and arcade sign were more common in the severe group than in the non-severe group, while predominant peripheral distribution, blurred edge, and fried egg sign were more common in the non-severe group than in the severe group. Conclusions: Thin-section chest CT scan can identify the abnormal imaging manifestations of the lung in patients with COVID-19 and evaluate the number, distribution range, and morphological characteristics of the lesions. Combined background diseases, number, distribution characteristics, blurred edge, large flake and band morphology, vascular bundle thickening, paving stone sign, arcade sign, and fried egg sign can effectively indicate the classification of patients with COVID-19. This can provide imaging evidence for the diagnosis and treatment of COVID-19.
  • 新型冠状病毒感染(coronavirus disease 2019,COVID-19)是由新型冠状病毒引起的一种急性呼吸道传染性疾病[1]。该病起病急、传播快、普遍易感,由于侵及呼吸道不同部位而临床表现多样,根据临床分型,将该病分为轻型、普通型、重型及危重型[2]。影像学检查对其的诊断价值不可替代,目前,大多数学者仅单纯探讨COVID-19的肺部影像学表现[3-5],而极少有文献报道影像学检查对于COVID-19分型的诊断价值。

    本文回顾性分析2022年12月20日至2022年12月31日于我院感染科诊断为COVID-19的134例患者,并根据临床分型进行分组,对于不同分型的COVID-19患者的临床特点及肺部影像学表现进行分析总结,以探讨胸部薄层CT平扫对于COVID-19分型的诊断价值,为临床诊断、治疗提供影像依据。

    回顾性收集2022年12月20日至2022年12月31日期间于北京大学第九临床医学院(首都医科大学附属北京世纪坛医院)感染科确诊为COVID-19的134例患者的临床及影像资料。入组标准:符合国家卫健委《新型冠状病毒感染诊疗方案(试行第十版)》[2]中的诊断标准,且具有完整的胸部薄层CT平扫影像资料。

    排除标准:不具备完整的临床资料及影像学检查资料的患者,胸部CT无异常的患者。134例新冠感染患者中,男73例(54.5%),女61例(45.5%),年龄26~98岁,平均年龄(69.6±15.0)岁,平均病程5 d,发热126例(94.0%),咳嗽120例(89.6%),肌痛21例(15.7%),咽痛42例(31.3%),胸闷14例(10.4%),腹泻9例(6.7%),纳差3例(2.2%),合并基础病87例(64.9%)。

    134例患者均接受胸部CT扫描,CT扫描仪为32排的北京赛诺威盛Insitum-CT 338机型,扫描参数设置:管电压120 kV,管电流150 mAs,螺距1.0。之后进行三维重建,横断面层厚为肺窗1.5 mm和纵隔窗5 mm,矩阵512×512,FOV 380~450;并进行冠状位和矢状位肺窗(1×5 mm)和纵隔窗(5×5 mm)重建。

    由两名放射科医师分别进行胸部CT平扫图像阅片,结果不一致时由另一位具有10年以上工作经验的高级医师评定最终阅片结果。

    CT主要指标包括:①病变数量:分为单发和多发,多发又分为≤5个、≤10个和>10个;②部位:单肺、单叶、双肺、对称、非叶段;③分布:周围、中央;其中周围分布分为胸膜下和胸膜内,中央分布又分为沿血管束和血管外;④分布优势:上肺为主、下肺为主、周围为主、中央为主、弥漫分布;⑤病变类型:磨玻璃、实变、网格影、蜂窝影、血管束增厚、混合等;⑥病变边缘:模糊、不规则、光整、分叶、毛刺;⑦形态类型:结节、树芽、斑片、大片、束带状、肿块样、混合;⑧其他征象:小气道壁增厚、血管束增厚、晕征、反晕征、铺路石征、支气管充气征、空气潴留征、拱廊征、煎蛋征、胸膜凹陷征、胸膜尾征、分叶征、空泡征、毛刺征、内部索条、胸膜下黑带、胸膜下线、牵拉性支扩、纤维索条。

    采用SPSS 26.0统计软件,对于不同分型的COVID-19患者的临床特点及肺部CT特征进行统计学分析,计量资料应用独立样本t检验,计数资料应用$\chi^2$检验,P<0.05为差异具有统计学意义。

    根据临床分型进行分组,非重症组110例,重症组24例。两组之间合并基础病的差异有统计学意义,且重症组合并基础病(83.3%)的发生率高于非重症组(60.9%);两组间合并糖尿病的差异具有统计学意义,且重症组(45.8%)合并糖尿病的发生率高于非重症组(25.5%)。两组间性别、年龄、平均病程及临床症状的差异均无统计学意义(表1)。

    表  1  134例新冠病毒感染患者的临床特点
    Table  1.  Clinical characteristics of 134 patients with COVID-19
    项目组别P
    非重症组(n=110)重症组(n=24)
       年龄68.5±15.274.3±12.60.090
       性别   男58(52.7)15(62.5)0.384
       女52(47.3) 9(37.5)0.384
       平均病程/d5.05.00.970
       临床特征/例   发热104(94.5) 22(91.7)0.949
       咳嗽100(90.9) 20(83.3)0.465
       咽痛35(31.8) 7(29.2)0.800
       胸闷11(10.0) 3(12.5)1.000
       肌痛17(15.5) 4(16.7)1.000
       腹泻8(7.3)1(4.2)0.920
       纳差2(1.8)1(4.2)0.450
       合并基础病/例67(60.9)20(83.3)0.037
       基础病类型/例   高血压42(38.2)12(50.0)0.285
       糖尿病28(25.5)11(45.8)0.046
       冠心病22(20.0) 9(37.5)0.065
       脑血管病16(14.5) 3(12.5)1.000
    下载: 导出CSV 
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    非重症组和重症组两组之间病变数量、对称性分布、周围为主分布、弥漫分布、边缘模糊(图1图5)、大片状(图4)、束带状、血管束增厚、铺路石征(图6)、拱廊征(图5)以及煎蛋征(图1)的差异有统计学意义。重症组的病灶数量>10个(图7)、对称性分布(图6)、弥漫分布、大片状、束带状(图8)、血管束增厚、铺路石征、拱廊征的发生率高于非重症组,而非重症组的周围为主分布、边缘模糊以及煎蛋征的发生率高于重症组(表2)。

    图  1  患者,男,非重症组,41岁,发热5 d,伴咽痛、流涕、咳嗽,Tmax 38.2℃,SPO2 98%。右肺背侧胸膜下见不规则煎蛋征(亚实性结节)(黑箭)
    Figure  1.  A 41-year-old male patient in the non-critical group had a fever for 5 days, accompanied by sore throat, running nose, cough, Tmax 38.2℃, and SPO2 98%. Irregular fried egg sign is observed in the right dorsal subpleural area (black arrow)
    图  2  患者,男,非重症组,63岁,发热5 d,伴咳嗽、咳痰,SPO2 97%。左肺胸膜下多发斑片状磨玻璃密度影
    Figure  2.  A 63-year-old male patient in the non-critical group had a fever for 5 days with cough and sputum and SPO2 97%. There are multiple patchy ground-glass opacities in the subpleural area of the left lung
    图  3  患者,女,非重症组,74岁,间断发热1周余,伴口干、厌食,Tmax 38.2℃,SPO2 98%。双下肺见不规则斑片状实变及磨玻璃密度影
    Figure  3.  A 74-year-old female patient in the non-critical group had an intermittent fever for more than 1 week, accompanied by dry mouth and anorexia, Tmax 38.2℃, and SPO2 98%. Irregular patchy high-density shadows are observed in both lower lungs
    图  4  患者,男,重症组,68岁,发热1周,伴咽痒、咳嗽,Tmax 39.3℃,SPO2 95%。右肺可见大片状磨玻璃密度影,胸膜内分布,可见胸膜下黑线(黑箭)
    Figure  4.  A 68-year-old male patient in the critical group had a fever for 1 week accompanied by an itchy throat and cough, Tmax 39.3℃, and SPO2 95%. A large flake of ground-glass opacity is seen in the right lung, distributed within the pleura, with a black subpleural line(black arrow)
    图  5  患者,女,重症组,87岁,咳嗽数天,发热1 h,Tmax 39.0℃,SPO2 89%~90%。右肺见斑片状实变及磨玻璃密度影,边缘略模糊,局部可见拱廊征(黑箭)
    Figure  5.  An 87-year-old female patient in the critical group had a fever for 1 hour with cough for several days, Tmax 39.0℃, and SPO2 89%~90%. Patchy consolidation and ground-glass opacity are seen in the right lung, with slightly blurred edges and arcade-like sign (black arrow)
    图  6  患者,女,重症组,83岁,发热7 d,伴咳嗽、咳痰,Tmax 39.0℃,SPO2 90.1%。双肺周围对称性分布片状磨玻璃密度影,其内可见铺路石征
    Figure  6.  An 83-year-old female patient in the critical group had a fever for 7 days with cough and sputum, Tmax 39.0℃, and SPO2 90.1%. The ground-glass opacities are symmetrically distributed around both lungs, and the paving stone sign can be seen within them
    图  7  患者,女,重症组,74岁,发热13 d,伴腹泻、呕吐、全身酸痛、咳嗽,Tmax 37.4℃。双肺多发实变影,沿支气管血管束分布,边缘清楚
    Figure  7.  A 74-year-old female patient in the critical group had a fever for 13 days, accompanied by diarrhea, emesis, body ache, cough, and Tmax 37.4℃. Multiple consolidations in both lungs are distributed along the bronchial vascular bundle with clear edges
    图  8  患者,女,重症组,89岁,发热10 d,伴心悸,Tmax 38.5℃。右下肺胸膜下见束带状高密度影(黑箭)
    Figure  8.  An 89-year-old female patient in the critical group had a fever for 10 days with palpitation and Tmax 38.5℃. A band-shaped high-density shadow is observed in the subpleural area of the lower lobe of the right lung (black arrow)
    表  2  不同分型的新冠病毒感染患者的肺部CT表现
    Table  2.  Imaging findings of different subtypes of patients with COVID-19
    项目参数  组别P
    非重型(n=110)重型(n=24)
    数量    单个    2(1.8)0(0.0)1.000
    多个    108(95.5) 24(100.0)1.000
    ≤5个   14(12.7)1(4.2)0.397
    ≤10个   24(21.8)1(4.2)0.085
    >10个   70(63.6)22(91.7)0.007
    部位    单肺    17(15.5)1(4.2)0.255
    单叶    10(9.1) 0(0.0)0.268
    双肺    94(85.5)23(95.8)0.296
    分布    对称    57(51.8)19(79.2)0.014
    非叶段   94(85.5)23(95.8)0.296
    周围    108(98.2) 23(95.8)0.450
    膜下    76(69.1)21(87.5)0.068
    膜内    104(94.5) 23(95.8)1.000
    中央    95(86.4)21(87.5)1.000
    血管束   95(86.4)21(87.5)1.000
    血管外   10(9.1) 4(16.7)0.465
    病变分布优势上肺为主  14(12.7)2(8.3)0.799
    下肺为主  50(45.5) 7(29.2)0.144
    周围为主  53(48.2) 5(20.8)0.014
    中央为主  20(18.2) 4(16.7)1.000
    弥漫    38(34.5)15(62.5)0.011
    病变类型  磨玻璃   102(92.7) 24(100.0)0.375
    实变    50(45.5)12(50.0)0.686
    网格    87(79.1)22(91.7)0.253
    蜂窝    10(9.1) 1(4.2)0.700
    混合    100(90.9) 24(100.0)0.268
    病变边缘  模糊    62(56.4) 8(33.3)0.041
    不规则   54(49.1) 7(29.2)0.076
    光整    1(0.9)0(0.0)1.000
    分叶    5(4.5)0(0.0)0.585
    毛刺    24(21.8) 3(12.5)0.453
    形态类型  结节    91(82.7)18(75.0)0.554
    树芽    42(38.2) 5(20.8)0.107
    斑片    89(80.9)23(95.8)0.138
    大片    57(51.8)19(79.2)0.014
    束带状   38(34.5)17(70.8)0.001
    肿块样   0(0.0)1(4.2)0.179
    混合    97(88.2)23(95.8)0.458
    征象    小气道壁厚 84(76.4)15(62.5)0.161
    血管束增厚 44(40.0) 24(100.0)0.000
    晕征    80(72.7)18(75.0)0.820
    反晕征   39(35.5)13(54.2)0.088
    铺路石   63(57.3)19(79.2)0.046
    支气管充气征78(70.9)21(87.5)0.094
    空气潴留征 38(34.5) 6(25.0)0.367
    拱廊征   38(34.5)15(62.5)0.011
    煎蛋征   63(57.3) 8(33.3)0.033
    胸膜凹陷征 21(19.1) 4(16.7)1.000
    胸膜尾征  54(49.1) 8(33.3)0.161
    分叶征   11(10.0)1(4.2)0.608
    空泡征   62(56.4)17(70.8)0.192
    毛刺征   50(45.5)11(45.8)0.973
    内部索条  35(31.8) 4(16.7)0.139
    胸膜下黑带 59(53.6)19(79.2)0.022
    胸膜下线  29(26.4) 4(16.7)0.318
    牵拉性支扩 61(55.5)17(70.8)0.166
    纤维索条  75(68.2)17(70.8)0.800
    下载: 导出CSV 
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    COVID-19是一种新型呼吸道传染性疾病,其致病病原体为一种单链RNA病毒SARS-CoV-2,该病有较强的传染性且人群普遍易感[4]。该病发病机制尚不十分清楚,可能是由病毒的S-蛋白与人血管紧张素转化酶Ⅱ相互作用感染人呼吸道上皮细胞所致[6]。其组织病理学包括:肺泡弥漫性损伤,肺泡间隔充血、水肿,单核细胞和淋巴细胞弥漫浸润,Ⅱ型肺泡上皮细胞显著增生并脱落,肺透明膜形成,微血管透明血栓的形成;疾病进展时肺泡腔内渗出实变,肺组织出现灶性出血及出血性梗死,肺泡腔渗出物机化以及肺间质纤维化导致肺泡结构破坏[7-8]。患者通常有流行病学史,临床表现主要为发热、咳嗽、咳痰、咽痛、肌痛、腹泻等[9]。老年人以及合并基础病的患者预后较差。

    本研究按照临床分型将新冠患者分为非重症组和重症组,两组之间合并基础病、合并糖尿病的差异有统计学意义,提示合并基础病的患者尤其是合并糖尿病的患者更容易出现重症感染,这与既往研究结果一致[10],可能与机体免疫能力有关,具体原因和机制有待进一步研究。

    胸部薄层CT平扫对于COVID-19的诊断具有独特优势,其可以显示肺部病变的影像学特征和累及范围,对于COVID-19的诊断以及分型具有指导价值。既往文献[3-5]报道,COVID-19肺部CT早期表现主要为多发斑片状或结节状磨玻璃密度影,双下肺外周背侧分布为主,多靠近胸膜并与胸膜平行,可伴有实变影及小叶间隔增厚,病灶内可见支气管充气征及血管束增粗等表现;随着疾病进展,病灶数量增多、范围增大,逐渐沿支气管血管束从外周向中央扩展,病灶密度增高,磨玻璃、实变或索条影等多种形态病变混合存在,可伴有牵拉性支扩,少数患者可见少量胸腔积液;严重者双肺呈弥漫性病变,实变影为主,部分患者呈“白肺”改变,可伴有支气管扩张、肺结构扭曲及肺不张等改变。

    本组研究发现,在COVID-19非重症组与重症组之间,在病灶数量、分布、边缘、形态、血管束增粗表现上有所差异。COVID-19肺部影像学大多表现为多发病灶,本组研究中多发病灶发生率为98.5%,可能是由于新冠病毒为RNA病毒,需要病毒在肺内达到一定数量才可致病,两组之间病灶数量>10个的差异具有统计学意义,提示重症患者的病灶数量多大于10个,这可能与肺内病毒感染数量有关。

    两组间周围为主分布、对称分布、弥漫分布以及大片状形态的差异具有统计学意义,非重症组周围为主分布的发生率(48.2%)高于重症组(20.8%),而重症组对称分布(79.2%)、弥漫分布(62.5%)以及大片状形态(79.2%)的发生率高于非重症组(51.8%、34.5% 和51.8%),这可能与疾病的发展过程有关,疾病早期,病变多分布于胸膜下和肺外周1/3,这可能与病毒直径较小,可以很快通过支气管首先到达胸膜下气体交换区域有关[11]

    随着疾病进展,病变数量逐渐增多,病灶逐渐融合呈大片状,向肺门或沿胸膜下蔓延至多个肺叶呈弥漫对称分布。两组间病变边缘模糊的差异具有统计学意义,且非重症组(56.4%)发生率高于重症组(33.3%),可能是由于非重症组病毒数量相对少且病毒直径小,容易通过肺泡孔扩散,引起邻近肺泡腔渗出所致[12],而重症组患者疾病进展较快,肺泡渗出增多,病灶密度增高,边缘相对清晰;两组间束带状形态的差异具有统计学意义,且重症组(70.8%)发生率高于非重症组(34.5%),可能是由于重症组患者疾病进程快,病灶此消彼长,呈现形态不规则、密度不均质、类型混杂性的特点[13],平行于胸膜的部分病灶出现机化收缩而呈现束带状。两组间血管束增粗的差异具有统计学意义,且重症组(100.0%)发生率高于非重症组(40.0%),可能是由于重症组患者血管周围间质水肿更重所致。

    既往文献[3-5,14-15]报道,COVID-19的肺部CT表现多伴有晕征、反晕征、铺路石征及支气管充气征等征象,而未有文献报道不同分型的COVID-19患者的影像学特殊征象的差异。铺路石征是指在磨玻璃密度病灶内可见网格影,两组间铺路石征的差异具有统计学意义,且重症组(79.2%)发生率高于非重症组(57.3%),可能是由于疾病早期主要以肺泡壁增厚、肺泡内浆液渗出为主,而间质增厚较少,随着疾病进展肺泡间隔扩张充血、小血管网增多以及小叶间隔间质水肿,从而铺路石征的表现增多[16]

    煎蛋征是指亚实性结节,即中心为实性成分、周围伴磨玻璃密度影的结节灶,两组间煎蛋征的差异具有统计学意义,且非重症组(57.3%)发生率高于重症组(33.3%),可能是由于病变早期结节样病灶相对多见,并且磨玻璃密度结节中心区域肺泡进一步损伤所致,而重症组患者病灶逐渐融合为片状,煎蛋样结节状病灶相对少见;拱廊征是指边缘清晰而弯曲的实变带,与胸膜围成拱形,是机化与纤维化的表现之一[13],两组间拱廊征的差异具有统计学意义,且重症组(62.5%)发生率高于非重症组(34.5%),可能是由于重症组疾病发展呈现更明显的多形性及混杂性,部分病灶内出现纤维化改变,可能表示该处肺组织处于修复状态。

    本研究的局限性:①未纳入临床实验室指标、治疗方法及患者预后等进行比较;②单纯比较不同分型新冠感染患者的影像学表现,未能进一步探讨影像分型与临床分型的相关性;③本研究以患者首诊 CT表现为主,未能进一步观察不同分型患者肺部病灶的动态演变规律。

    综上所述,胸部薄层CT平扫能够明确COVID-19患者肺部异常影像学表现,准确评估病灶数量、分布范围、形态特点,其中病灶数量、分布特点、病灶边缘、形态类型及铺路石征、拱廊征、煎蛋征等特殊征象能够有效提示COVID-19的分型,对于COVID-19的精准诊断、治疗选择及患者预后具有重要意义。

  • 图  1   患者,男,非重症组,41岁,发热5 d,伴咽痛、流涕、咳嗽,Tmax 38.2℃,SPO2 98%。右肺背侧胸膜下见不规则煎蛋征(亚实性结节)(黑箭)

    Figure  1.   A 41-year-old male patient in the non-critical group had a fever for 5 days, accompanied by sore throat, running nose, cough, Tmax 38.2℃, and SPO2 98%. Irregular fried egg sign is observed in the right dorsal subpleural area (black arrow)

    图  2   患者,男,非重症组,63岁,发热5 d,伴咳嗽、咳痰,SPO2 97%。左肺胸膜下多发斑片状磨玻璃密度影

    Figure  2.   A 63-year-old male patient in the non-critical group had a fever for 5 days with cough and sputum and SPO2 97%. There are multiple patchy ground-glass opacities in the subpleural area of the left lung

    图  3   患者,女,非重症组,74岁,间断发热1周余,伴口干、厌食,Tmax 38.2℃,SPO2 98%。双下肺见不规则斑片状实变及磨玻璃密度影

    Figure  3.   A 74-year-old female patient in the non-critical group had an intermittent fever for more than 1 week, accompanied by dry mouth and anorexia, Tmax 38.2℃, and SPO2 98%. Irregular patchy high-density shadows are observed in both lower lungs

    图  4   患者,男,重症组,68岁,发热1周,伴咽痒、咳嗽,Tmax 39.3℃,SPO2 95%。右肺可见大片状磨玻璃密度影,胸膜内分布,可见胸膜下黑线(黑箭)

    Figure  4.   A 68-year-old male patient in the critical group had a fever for 1 week accompanied by an itchy throat and cough, Tmax 39.3℃, and SPO2 95%. A large flake of ground-glass opacity is seen in the right lung, distributed within the pleura, with a black subpleural line(black arrow)

    图  5   患者,女,重症组,87岁,咳嗽数天,发热1 h,Tmax 39.0℃,SPO2 89%~90%。右肺见斑片状实变及磨玻璃密度影,边缘略模糊,局部可见拱廊征(黑箭)

    Figure  5.   An 87-year-old female patient in the critical group had a fever for 1 hour with cough for several days, Tmax 39.0℃, and SPO2 89%~90%. Patchy consolidation and ground-glass opacity are seen in the right lung, with slightly blurred edges and arcade-like sign (black arrow)

    图  6   患者,女,重症组,83岁,发热7 d,伴咳嗽、咳痰,Tmax 39.0℃,SPO2 90.1%。双肺周围对称性分布片状磨玻璃密度影,其内可见铺路石征

    Figure  6.   An 83-year-old female patient in the critical group had a fever for 7 days with cough and sputum, Tmax 39.0℃, and SPO2 90.1%. The ground-glass opacities are symmetrically distributed around both lungs, and the paving stone sign can be seen within them

    图  7   患者,女,重症组,74岁,发热13 d,伴腹泻、呕吐、全身酸痛、咳嗽,Tmax 37.4℃。双肺多发实变影,沿支气管血管束分布,边缘清楚

    Figure  7.   A 74-year-old female patient in the critical group had a fever for 13 days, accompanied by diarrhea, emesis, body ache, cough, and Tmax 37.4℃. Multiple consolidations in both lungs are distributed along the bronchial vascular bundle with clear edges

    图  8   患者,女,重症组,89岁,发热10 d,伴心悸,Tmax 38.5℃。右下肺胸膜下见束带状高密度影(黑箭)

    Figure  8.   An 89-year-old female patient in the critical group had a fever for 10 days with palpitation and Tmax 38.5℃. A band-shaped high-density shadow is observed in the subpleural area of the lower lobe of the right lung (black arrow)

    表  1   134例新冠病毒感染患者的临床特点

    Table  1   Clinical characteristics of 134 patients with COVID-19

    项目组别P
    非重症组(n=110)重症组(n=24)
       年龄68.5±15.274.3±12.60.090
       性别   男58(52.7)15(62.5)0.384
       女52(47.3) 9(37.5)0.384
       平均病程/d5.05.00.970
       临床特征/例   发热104(94.5) 22(91.7)0.949
       咳嗽100(90.9) 20(83.3)0.465
       咽痛35(31.8) 7(29.2)0.800
       胸闷11(10.0) 3(12.5)1.000
       肌痛17(15.5) 4(16.7)1.000
       腹泻8(7.3)1(4.2)0.920
       纳差2(1.8)1(4.2)0.450
       合并基础病/例67(60.9)20(83.3)0.037
       基础病类型/例   高血压42(38.2)12(50.0)0.285
       糖尿病28(25.5)11(45.8)0.046
       冠心病22(20.0) 9(37.5)0.065
       脑血管病16(14.5) 3(12.5)1.000
    下载: 导出CSV

    表  2   不同分型的新冠病毒感染患者的肺部CT表现

    Table  2   Imaging findings of different subtypes of patients with COVID-19

    项目参数  组别P
    非重型(n=110)重型(n=24)
    数量    单个    2(1.8)0(0.0)1.000
    多个    108(95.5) 24(100.0)1.000
    ≤5个   14(12.7)1(4.2)0.397
    ≤10个   24(21.8)1(4.2)0.085
    >10个   70(63.6)22(91.7)0.007
    部位    单肺    17(15.5)1(4.2)0.255
    单叶    10(9.1) 0(0.0)0.268
    双肺    94(85.5)23(95.8)0.296
    分布    对称    57(51.8)19(79.2)0.014
    非叶段   94(85.5)23(95.8)0.296
    周围    108(98.2) 23(95.8)0.450
    膜下    76(69.1)21(87.5)0.068
    膜内    104(94.5) 23(95.8)1.000
    中央    95(86.4)21(87.5)1.000
    血管束   95(86.4)21(87.5)1.000
    血管外   10(9.1) 4(16.7)0.465
    病变分布优势上肺为主  14(12.7)2(8.3)0.799
    下肺为主  50(45.5) 7(29.2)0.144
    周围为主  53(48.2) 5(20.8)0.014
    中央为主  20(18.2) 4(16.7)1.000
    弥漫    38(34.5)15(62.5)0.011
    病变类型  磨玻璃   102(92.7) 24(100.0)0.375
    实变    50(45.5)12(50.0)0.686
    网格    87(79.1)22(91.7)0.253
    蜂窝    10(9.1) 1(4.2)0.700
    混合    100(90.9) 24(100.0)0.268
    病变边缘  模糊    62(56.4) 8(33.3)0.041
    不规则   54(49.1) 7(29.2)0.076
    光整    1(0.9)0(0.0)1.000
    分叶    5(4.5)0(0.0)0.585
    毛刺    24(21.8) 3(12.5)0.453
    形态类型  结节    91(82.7)18(75.0)0.554
    树芽    42(38.2) 5(20.8)0.107
    斑片    89(80.9)23(95.8)0.138
    大片    57(51.8)19(79.2)0.014
    束带状   38(34.5)17(70.8)0.001
    肿块样   0(0.0)1(4.2)0.179
    混合    97(88.2)23(95.8)0.458
    征象    小气道壁厚 84(76.4)15(62.5)0.161
    血管束增厚 44(40.0) 24(100.0)0.000
    晕征    80(72.7)18(75.0)0.820
    反晕征   39(35.5)13(54.2)0.088
    铺路石   63(57.3)19(79.2)0.046
    支气管充气征78(70.9)21(87.5)0.094
    空气潴留征 38(34.5) 6(25.0)0.367
    拱廊征   38(34.5)15(62.5)0.011
    煎蛋征   63(57.3) 8(33.3)0.033
    胸膜凹陷征 21(19.1) 4(16.7)1.000
    胸膜尾征  54(49.1) 8(33.3)0.161
    分叶征   11(10.0)1(4.2)0.608
    空泡征   62(56.4)17(70.8)0.192
    毛刺征   50(45.5)11(45.8)0.973
    内部索条  35(31.8) 4(16.7)0.139
    胸膜下黑带 59(53.6)19(79.2)0.022
    胸膜下线  29(26.4) 4(16.7)0.318
    牵拉性支扩 61(55.5)17(70.8)0.166
    纤维索条  75(68.2)17(70.8)0.800
    下载: 导出CSV
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  • 被引次数: 0
出版历程
  • 收稿日期:  2023-03-06
  • 录用日期:  2023-04-13
  • 网络出版日期:  2023-04-19
  • 发布日期:  2023-09-21

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