甲型H1N1流感肺炎胸部CT表现半定量评分与病毒载量的相关性研究  

Correlative study of semi-quantitative score of chest CT findings and viral load in novel influenza A (H1N1) virus infection

作　　者：邓莹莹[1] 陆普选[1] 杨桂林[2] 刘威龙[2] 刘映霞[3] 叶如馨[1] 马威[1] 周伯平[1] 

机构地区：[1]深圳市第三人民医院放射科,广东518020 [2]深圳市第三人民医院肝病研究所,广东518020 [3]深圳市第三人民医院感染科,广东518020

出　　处：《放射学实践》2010年第9期965-968,共4页Radiologic Practice

摘　　要：目的:探讨甲型H1N1流感肺炎的胸部影像表现及HRCT评分与病毒载量的相关性。方法:对21例甲型H1N1流感肺炎核酸检测阳性的患者进行甲型H1N1流感病毒载量测定,并进行胸部CT扫描(含HRCT)检查,同时进行CT评分。观察CT表现及相应病毒载量变化,并进行统计学分析处理。结果:①21例甲型H1N1流感肺炎患者于发病第4天CT评分均值最高为5.9分,以磨玻璃密度及实变影为主,于发病第5天病毒载量最高为5.77copies/ml;②孕产妇及有基础疾病组入院初次病毒载量较无基础疾病组低(分别为3.76copies/ml和5.02copies/ml),差异具统计学意义(P<0.05);③CT评分孕产妇及有基础疾病组高于无基础疾病组(分别为6.13分和3.38分),但差异无统计学意义(P>0.05);④动态观察10例甲型H1N1流感肺炎患者中7例病毒转阴时间快于肺内病灶吸收时间,而3例年幼患者病毒转阴时间明显延长,肺内病灶吸收较快。结论:甲型H1N1流感肺炎的胸部CT表现半定量评分与病毒载量无明显相关性。成年患者临床症状的改善、病毒转阴时间快于肺内病灶的吸收时间,而儿童则相反。临床甲流相关性肺炎肺内病灶的吸收不等于病毒在体内完全消失,尤其是儿童。Objective：To evaluate the chest imaging findings and high resolution CT （HRCT） score in patients with novel influenza A （H1N1） pneumonia,and the relationship of imaging characteristics and viral load.Methods：21 patients had influenza A （H1N1） pneumonia with positive nucleic acid test received viral load measurement,thoracic CT scanning （including HRCT） and CT score were performed.The CT findings and related viral load changes were observed and analyzed statistically.Results：①of the 21 patients,the highest CT score was 5.9 points on the 4th day after onset of illness,ground-glass opacities （GGO） and consolidation were the major CT features.The highest viral load was up to 5.77copies/ml on the 5th day after onset;②In pregnant women and patients with underlying diseases,the initial viral load was lower than those without underlying disease （3.76copies/ml vs 5.02copies/ml） with significant statistical difference （P0.05）;③The CT scores of pregnant women with underlying diseases were higher than those without underlying disease （6.13 points vs 3.38 points）,yet with no significant statistical difference （P0.05）;④Follow-up observation of 10 patients with novel influenza A （H1N1） pneumonia,the viral clearance time preceded to the absorption time of pulmonary lesions in 7 patients,yet the viral clearance time in 3 pediatric patients was markedly prolonged with earlier absorption of pulmonary lesions.Conclusion：Pulmonary CT score had no obvious correlation with viral load in novel influenza A （H1N1） pneumonia patients.In adult patients,the improvement of clinical symptoms and viral clearance time preceded to absorption of pulmonary lesions,whereas which was the opposite in pediatric patients.It suggested that absorption of pulmonary lesions in influenza A （H1N1） pneumonia does not equal to the disappearance of virus in vivo,especially in children.

关 键 词：甲型H1N1流感 肺炎 病毒载量 体层摄影术 X线计算机 

分 类 号：R511.7[医药卫生—内科学] R814.42[医药卫生—临床医学]