吸气相与呼气相高分辨CT定量评估甲型H1N1流感肺部后遗损伤  

Quantitative Evaluation of Pulmonary Sequelae in Novel Swine-Origin Influenza A( H1N1) Virus Infection by Inspiratory and Expiratory HRCT

作　　者：李平[1] 季诚[2] 陈铟铟[1] 郭亮[1] 李勇刚[1] 

机构地区：[1]苏州大学附属第一医院放射科,苏州215006 [2]苏州大学附属第一医院呼吸内科,苏州215006

出　　处：《临床放射学杂志》2014年第1期39-44,共6页Journal of Clinical Radiology

基　　金：国家自然科学基金项目(编号：81171394);江苏省自然科学基金项目(编号：BK2011307)

摘　　要：目的采用吸气相与呼气相高分辨CT定量评估甲型H1N1流感患者肺部后遗损伤程度并观察其演变规律。方法35例甲型H1N1流感肺部合并症患者分为两组，其中，危重组8例，重症组27例。所有患者出院后6～7个月行胸部吸气相与呼气相高分辨CT扫描，其中24例患者接受了肺功能检查。19例患者于出院后18个月再次复查高分辨CT，其中危重组7例，重症组12例。对患者胸部CT异常征象进行定量评分，两组患者各项评分进行统计学分析，并将影像学评分与肺功能检查结果进行相关性分析。结果危重组住院期间、出院后6～7个月及18个月复查胸部CT评分平均得分分别为17．75分、12．38分及11．14分。重症组住院期间及二次复查平均得分分别为8．59分、3．67分、3．67分，两组间差异均有显著统计学意义（P〈0．05）。磨玻璃影、间质性病变及实变影首诊阳性率分别为62．9％（22／35）、42．9％（15／35）及40％（14／35）。6个月后复查，阳性率分别为14．3％（5／35）、54．3％（19／35）及0。18个月后复查阳性率分别为5．2％（1／19）、63．2％（12／19）及0。空气储留征6个月后及18个月后复查阳性率分别为54．3％（19／35）、68．4％（13／19）。6～7个月复查，24例患者肺一氧化碳扩散量（DLCO）值与肺部病变影像定量评分呈显著性负相关，相关系数为一0．608。结论甲型H1N1流感肺损伤早期多表现为磨玻璃影，晚期后遗损伤主要表现为间质性病变及空气储留征，吸气相与呼气相高分辨CT定量评分能反映甲型H1N1流感肺部后遗损伤程度。Objective To quantitatively evaluate the severity and explore the variation process of pulmonary sequelae on paired inspiration-expiration HRCT in patients recovering from novel swine-origin influenza A （H1 N1 ） virus infection. Methods Of 35 patients with pulmonary complication caused by pandemic influenza A （ H1 N1 ） virus infection, 8 and 27 were assigned to the critically-ill group and severe group, respectively. All patients underwent pulmonary HRCT in 6 to 7 months after discharge, among which 24 patients accepted pulmonary function test at the same time. Of 35 patients, 19 pa- tients （7 cases in critically-ill group, 12 cases in severe group） underwent the second follow up HRCT examination in 18 months after discharge. Lung abnormal findings were scored according to extent and statistic analysis of scores in different radiologic findings was done between critically-ill group and severe group. Score of radiologic abnormal signs was correlated with the findings of pulmonary function test. Results The average radiologic scores of patients in critically-ill group among hospitalization, 6 and 18 months after discharge were respectively 17.75, 12.38 and 11.14, while the average scores in se- vere group were 8.59, 3.67 and 3.67. There was a statistic difference between the two groups（ P 〈 0.05 ）. Ground-glass o- pacity, interstitial opacity and consolidation were found in 22 （62.9%） ,15 （42.9%） and 14 （40%） of all 35 cases, re- spectively, at initial thin-slice CT examination and in 5 （ 14.3 % ）, 19 （54.3 % ） and 0 of 35 cases, respectively at follow up examination 6 -7 months after discharge. At the second follow up CT examination, the positive rate was 5.2% （ 1/19 ）,63.2% （12/19） and 0, respectively. Air trapping was found in 19 （54.3 % ） of 35 cases and 13 （68.4%） of 19 cases at the first and second follow up HRCT examination, respectively. DLCO values were significant negative correlative with the scores of abnormal radiologic findings in 24 patients and t

关 键 词：甲型H1N1病毒感染 肺 合并症 体层摄影术 X线计算机 

分 类 号：R511.7[医药卫生—内科学]