新型冠状病毒肺炎的临床与CT特征初步观察

doi:10.3969/j.issn.1006-7795.2020.02.019

首都医科大学学报 ›› 2020, Vol. 41 ›› Issue (2): 257-260.doi: 10.3969/j.issn.1006-7795.2020.02.019

新型冠状病毒肺炎的临床与CT特征初步观察

李小虎¹, 邱晓辉², 张金平³, 曾小松⁴, 徐启中⁵, 黄国权⁶, 贺克武⁷, 马宜传⁸, 吴宗山⁹, 史恒峰¹⁰, 袁玉山¹¹, 刘斌¹, 余永强¹

1. 安徽医科大学第一附属医院放射科安徽省影像诊断医疗质量控制中心, 合肥 230022;
2. 亳州市第一人民医院放射科, 安徽亳州 236800;
3. 铜陵市人民医院放射科, 安徽铜陵 244000;
4. 安徽医科大学附属宿州医院放射科, 安徽宿州 234000;
5. 安徽医科大学附属巢湖医院放射科, 安徽巢湖 238001;
6. 芜湖市第二人民医院放射科, 安徽芜湖 241001;
7. 合肥市第一人民医院放射科, 安徽合肥 230001;
8. 蚌埠医学院第一附属医院放射科, 安徽蚌埠 233004;
9. 安徽医科大学附属六安医院, 安徽六安 237005;
10. 安徽医科大学附属安庆医院放射科, 安徽安庆 246003;
11. 阜阳市人民医院放射科, 安徽阜阳 236000

收稿日期:2020-02-28 出版日期:2020-04-21 发布日期:2020-04-16
通讯作者: 余永强 E-mail:cjr.yuyongqiang@vip.163.com
基金资助:
安徽省应急科研攻关项目（20200410702003），安徽省科技攻关项目（201904a07020060），安徽省高校自然科学基金重点项目（KJ2018A0197）。

Clinical presentations and CT features of COVID-19

Li Xiaohu¹, Qiu Xiaohui², Zhang Jinping³, Zeng Xiaosong⁴, Xu Qizhong⁵, Huang Guoquan⁶, He Kewu⁷, Ma Yichuan⁸, Wu Zongshan⁹, Shi Hengfeng¹⁰, Yuan Yushan¹¹, Liu Bin¹, Yu Yongqiang¹

1. Department of Radiology, the First Affiliated Hospital of Anhui Medical University, Anhui Province Clinical Image Quality Control Center, Hefei 230022, China;
2. Department of Radiology, The People's Hospital of Bozhou, Bozhou 236800, Anhui Province, China;
3. Department of Radiology, Tongling People's Hospital, Tongling 244000, Anhui Province, China;
4. Department of Radiology, Suzhou Hospital Affiliated to Anhui Medical University, Suzhou 234000, Anhui Province, China;
5. Department of Radiology, Chaohu Hospital of Anhui Medical University, Chaohu 238001, Anhui Province, China;
6. Department of Radiology, The Second People's Hospital of Wuhu, Wuhu 241001, Anhui Province, China;
7. Department of Radiology, The First People's Hospital of Hefei, Hefei 230001, China;
8. Department of Radiology, the First Affiliated Hospital of Bengbu Medical college, Bengbu 233004, Anhui Province, China;
9. Department of Radiology, The Lu'an affiliated hospital, Anhui Medical University, Lu'an 237005, Anhui Province, China;
10. Department of Radiology, Anqing Municipal Hospital, Anqing 246003, Anhui Province, China;
11. Department of Radiology, Fu Yang People's Hospital, Fuyang 236000, Anhui Province, China

Received:2020-02-28 Online:2020-04-21 Published:2020-04-16
Supported by:
This study was supported by Anhui Natural Science Emergency Foundation （20200410702003）， Anhui Province Programs for Science and Technology Development（201904a07020060），Intercollegiate Key Projects of Nature Science of Anhui Province （KJ2018A0197）. ^#共同第一作者

摘要/Abstract

摘要： 目的初步探讨新型冠状病毒肺炎（COVID-19）的临床和胸部电子计算机断层扫描（computed tomography，CT）影像学表现。方法回顾性分析26例确诊COVID-19患者的临床和胸部CT影像学资料。结果临床表现主要为发热26例（100%），咳嗽21例（80.8%），可伴随肌肉酸痛、胸闷、腹泻或呕吐症状。实验室检查白细胞计数正常15例（57.7%），高于正常4例（15.4%），低于正常7例（26.9%）。淋巴细胞计数减少10例（38.5%）。15例（57.7%）患者C反应蛋白升高。26例COVID-19患者CT表现均有异常，6例（23.1%）表现为单侧肺叶病变，以胸膜下分布为主；20例（76.9%）双侧肺叶受累。6例（23.1%）患者双肺所有肺叶、肺段均受累；局灶性病例中以右肺下叶受累最多见10例（38.5%）。26例COVID-19患者可见下述一种或多种征象：磨玻璃影像（ground glass opacity，GGO）16例（61.5%），以胸膜下分布为主；6例（23.1%）表现为GGO合并局灶实变影；10例（38.5%）为小斑片状边缘模糊密度增高影；7例（26.9%）为大片状实变影；8例（30.8%）可见网格状或纤维条索影；5例（19.2%）患者可见血管束增粗和血管穿行；4例（15.4%）患者可见空气支气管征象；1例（3.8%）患者可见少量胸腔积液，未见纵隔及肺门淋巴结肿大。结论 COVID-19的胸部CT表现为多部位、外周、胸膜下、下叶分布的磨玻璃影，可伴有实变，胸腔积液及肿大淋巴结少见，CT检查为该病的早期防控、早期诊断及治疗提供了重要依据。

关键词: 冠状病毒, 新型冠状病毒肺炎, 电子计算机断层扫描

Abstract: Objective To investigate the thoracic computed tomography(CT) and clinical manifestations of COVID-19. Methods Chest CT and clinical data of confirmed 26 patients COVID-19 were retrospectively analyzed. Results In terms of clinical manifestations, fever and cough were main manifestations with 26 patients (100%) and 21 patients (80.8%) respectively, which could be accompanied by muscle soreness, shortness of breath, diarrhea or vomiting. Laboratory examination showed that 15 patients (57.7%) was normal in white blood cell (WBC),4 patients (15.4%) increased and 7 patients (26.9%) decreased. Lymphocytopenia occurred in 10 patients (38.5%). C-reactive protein(CRP) was elevated in 15 patients (57.7%). In terms of CT features, lesions were found in the lung high resolution computerized tomography(HRCT) of 26 all patients, with unilateral lung distribution in 6 patients (23.1%), mainly subpleural distribution;bilateral lung distribution in 20 patients (76.9%). All lobes and segments of both lungs were involved in 6 patients (23.1%). In focal cases, the involvement of the right lower lobe was the most common with 10 patients (38.5%). One or more of the following signs could be seen in 26 patients with COVID-19:ground -glass opacity(GGO) in 16 patients (61.5%), mainly subpleural distribution;GGO combined with focal consolidation in 6 patients (23.1%); small patchy blur with increased density in 10 patients (38.5%); large patchy consolidation in 7 patients (26.9%); fibrosis, grid shadow in 8 patients (30.8%); bronchovascular bundle thickening and vascular perforator sign were seen in 5 patients (19.2%); air bronchial signs were seen in 4 patients (15.4%); a small amount of pleural effusion was seen in 1 patient (3.8%). Enlargement of mediastinal and hilar lymph nodes was absent. Conclusion Chest CT of COVID-19 shows GGO distributed in multiple sites, periphery, subpleural and lower lobes, which may be accompanied by consolidation. Pleural effusion and enlarged lymph nodes are rare. Chest CT provides an important basis for early prevention and control, early diagnosis and treatment of the disease.

Key words: coronavirus, COVID-19, computed tomography (CT)

中图分类号:

R563.1

李小虎, 邱晓辉, 张金平, 曾小松, 徐启中, 黄国权, 贺克武, 马宜传, 吴宗山, 史恒峰, 袁玉山, 刘斌, 余永强. 新型冠状病毒肺炎的临床与CT特征初步观察[J]. 首都医科大学学报, 2020, 41(2): 257-260.

Li Xiaohu, Qiu Xiaohui, Zhang Jinping, Zeng Xiaosong, Xu Qizhong, Huang Guoquan, He Kewu, Ma Yichuan, Wu Zongshan, Shi Hengfeng, Yuan Yushan, Liu Bin, Yu Yongqiang. Clinical presentations and CT features of COVID-19[J]. Journal of Capital Medical University, 2020, 41(2): 257-260.

参考文献

[1] Zhu N, Zhang D, Wang W, et al. A novel coronavirus from patients with pneumonia in China,2019[J]. N Engl J Med,2020,382(8):727-733.
[2] Munster V J, Koopmans M, van Doremalen N, et al. A novel coronavirus emerging in China-key questions for impact assessment[J]. N Engl J Med,2020,382(8):692-694.
[3] 国家卫生健康委办公厅.新型冠状病毒感染的肺炎诊疗方案(试行第六版)[EB/OL].(2020-02-21)[2020-02-28]. http://www.nhc.gov.cn/yzygj/s7652m/202002/54e1ad5c2aac45c19eb541799bf637e9.shtml.
[4] 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):497-506.
[5] Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia[J]. N Engl J Med, 2020,Epub ahead of print.
[6] 中华医学会放射学分会.新型冠状病毒肺炎的放射学诊断:中华医学会放射学分会专家推荐意见(第一版)[J/OL].中华放射学杂志.(2020-01-29)[2020-02-28).http://doi:10.3760/cma.j.issn.1005-1201.2020.0001
[7] 中华医学会放射学分会传染病学组,中国医师协会放射医师分会感染影像专委会,中国研究型医院学会感染与炎性反应放射学专委会,等.新型冠状病毒感染的肺炎影像学诊断指南(2020第一版)\[J/OL].医学新知.(2020-01-29)[2020-02-28]. https://doi.org/10.12173/j.issn.1004-5511.2020.01.07.
[8] 黄璐,韩瑞,于朋鑫,等.新型冠状病毒肺炎不同临床分型间CT和临床表现的相关性研究[J].中华放射学杂志,2020, 54(2):172-176.
[9] 陆雪芳,龚威,王莉,等.新型冠状病毒肺炎初诊临床特征及高分辨率CT影像表现[J].中华放射学杂志,2020,54:E006.
[10] Koo H J, Lim S, Choe J, et al. Radiographic and CT Features of Viral Pneumonia[J]. Radiographics,2018,38(3):719-739.
[11] 程晓光,冯素臣,夏国光,等.SARS的胸部CT早期表现[J].中华放射学杂志,2003,37(9):790-793.

[1]	邱雅若, 李星霖, 陈丹瑛, 刘永梅, 宋焱君, 李国力, 宋川, 王玺, 赵学森. 新型冠状病毒Omicron变异株利用多种动物ACE2作为受体侵入细胞的能力[J]. 首都医科大学学报, 2022, 43(3): 421-426.
[2]	王爽, 潘阳, 徐新民, 栗雅杰, 周淳, 张悦, 王雅杰. 新型冠状病毒核酸PCR检测假阳性核酸污染类型的鉴别方法[J]. 首都医科大学学报, 2022, 43(3): 427-432.
[3]	刘珊珊, 陈旭, 李亚琼, 袁晓菲, 于红晔, 房萌. 新型冠状病毒肺炎疫情期间北京市青少年抑郁焦虑情况调查及影响因素[J]. 首都医科大学学报, 2021, 42(3): 412-417.
[4]	陈剑明, 陈腾飞, 连博, 陈奕杉, 徐霄龙, 刘清泉. 新型冠状病毒肺炎中医证候和证候要素分布特点的文献分析[J]. 首都医科大学学报, 2020, 41(6): 901-907.
[5]	尹星琪, 于彩果, 柯静, 赵冬, 于可. 2型糖尿病患者新型冠状病毒肺炎流行期间心理状态及行为调查[J]. 首都医科大学学报, 2020, 41(6): 970-977.
[6]	姚春勇, 李杨帆, 贾原菊. 66例新型冠状病毒肺炎患者临床特点及胸部电子计算机断层扫描影像表现分析[J]. 首都医科大学学报, 2020, 41(6): 997-1001.
[7]	慕萌, 张俊敏, 陈瑞芳, 孙超渊. 医学类科技期刊应对新型冠状病毒肺炎(COVID-19)的策略分析——以《首都医科大学学报》为例[J]. 首都医科大学学报, 2020, 41(6): 1033-1036.
[8]	张露平, 阮祥燕, 鞠蕊, 秦爽, 王宾红, 许新, 杨瑜, Alfred O. Mueck. 围绝经期及绝经后女性基于腰椎定量电子计算机断层扫描测定的内脏脂肪与糖脂代谢的相关性[J]. 首都医科大学学报, 2020, 41(4): 508-513.
[9]	安彦虹, 戎冬冬, 单艺, 武春雪, 高艳, 卢洁. 新型冠状病毒肺炎疑似与确诊患者的胸部X线表现比较[J]. 首都医科大学学报, 2020, 41(4): 608-612.
[10]	胡琪, 钟正, 刘激扬, 汤渝玲, 周志国, 刘萍, 阎昱升, 李波. 57例新型冠状病毒肺炎治愈患者胸部电子计算机断层扫描特征报告[J]. 首都医科大学学报, 2020, 41(4): 627-630.
[11]	杨毅, 鲁旭然, 刘楠, 侯晓彤, 孙立忠, 吴龙, 潘友民, 王守凤, 赵欣艳. 新型冠状病毒肺炎对心血管系统影响[J]. 首都医科大学学报, 2020, 41(4): 657-663.
[12]	刘景院, 郭贺冰, 李昂. 危重型新型冠状病毒肺炎的诊疗进展[J]. 首都医科大学学报, 2020, 41(3): 321-327.
[13]	刘景院, 郭贺冰, 李昂. 新型冠状病毒肺炎诊疗的若干思考[J]. 首都医科大学学报, 2020, 41(3): 328-335.
[14]	郭晶晶, 方茜, 刘亚楠, 曲沛, 马雪瀛, 王爽, 方伟, 周茹, 张响, 汤云霞, 杨思园, 于凤婷, 王雅杰. 31例新型冠状病毒感染病例咽拭子与痰标本病毒核酸检测的比较[J]. 首都医科大学学报, 2020, 41(3): 336-339.
[15]	吕志彬, 关春爽, 闫铄, 陈七一, 李晶晶, 张羽君, 陈步东, 谢汝明. 人工智能在CT预测新型冠状病毒肺炎转归中的价值[J]. 首都医科大学学报, 2020, 41(3): 340-344.

新型冠状病毒肺炎的临床与CT特征初步观察

Clinical presentations and CT features of COVID-19

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价