新型冠状病毒肺炎的临床特征、CT表现与动态变化  

Clinical features,CT manifestations and dynamic changes of COVID-19

作　　者：叶晓雪 谢益兵 许崇永[2] 徐慧[2] 严志汉[2] 方必东[2] 杨超颖 陈梅魁[2] 陈棋[2] YE Xiaoxue;XIE Yibing;XU Chongyong;XU Hui;YAN Zhihan;FANG Bidong;YANG Chaoying;CHEN Meikui;CHEN Qi(Department of Radiology,Yongjia County People’s Hospital,Wenzhou 325100,China;Department of Radiology,the Second Affiliated Hospital of Wenzhou Medical University,Wenzhou 325027,China)

机构地区：[1]永嘉县人民医院放射科,浙江温州325100 [2]温州医科大学附属第二医院放射科,浙江温州325027

出　　处：《温州医科大学学报》2020年第3期182-186,共5页Journal of Wenzhou Medical University

基　　金：温州市科技局科研基金资助项目(2018Y1563)。

摘　　要：目的:探讨新型冠状病毒肺炎(COVID-19)患者的临床特征、CT表现与动态变化。方法:收集2020年1月20日至2月10日永嘉县人民医院收治的COVID-19患者39例,回顾性分析其临床及实验室特点、CT表现与动态变化。结果:39例COVID-19患者中,轻型3例,普通型28例,重型8例,其中37例患者有明确流行病学史,入院首诊外周血白细胞计数降低5例,淋巴细胞计数降低7例,18例C反应蛋白升高,35例血清淀粉样蛋白A升高。患者出院前临床症状减轻,实验室指标基本恢复正常。肺部病变呈自然进程,入院初诊CT表现为胸膜下小斑片状、结节状磨玻璃密度影,伴或不伴小叶间隔增厚;入院3~6 d CT多表现为病灶增多、范围扩大,实变明显,可见空气支气管征,新发病变呈较淡薄磨玻璃密度影,以两肺中下叶胸膜下分布为主;入院9~11 d CT多数表现为病变范围缩小、密度减低,4例完全吸收,3例残留少许纤维灶病变。结论:COVID-19的临床表现及CT动态变化具有一定特征性,深入了解并认识COVID-19的CT表现可以弥补病毒核酸检验的假阴性现象,以便患者早期隔离、早期干预。Objective:To explore the clinical characteristics,CT manifestations and dynamic changes of patients with corona virus disease 2019(COVID-19).Methods:A total of 39 patients with COVID-19 from Yongjia County People’s Hospital during January 202020 to February 102020 were collected,and their clinical and laboratory characteristics,CT manifestations and dynamic changes were retrospectively analyzed.Results:Of 39 COVID-19 patients,3 were mild,28 normal and 8 severe;37 of them had a clear epidemiological history.In the first admission,peripheral blood leukocyte counts decreased in 5 cases,lymphocyte counts decreased in 7 cases,and C-reactive protein levels increased in 18 cases,serum amyloid A levels increased in 35 patients.By the time of discharge,their clinical symptoms were obviously relieved,and laboratory indicators of peripheral blood returned to normal.Pulmonary lesions showed a natural course.On admission,the initial CT manifestations included subpleural patchy,nodular ground glass density shadows,with or without thickening of the lobular septum.3 to 6 days after admission,the lesions increased,the scope expanded,and the consolidation became obvious,and air bronchus signs were seen.The new lesions showed a thin ground-glass density shadow,and the subpleural distribution of the middle and lower lobe of both lungs was dominant.9 to 11 days after admission,CT showed that the lesion area and density were reduced in mose cases,completely absorbed in 4 cases,and fibrous lesions remained in 3 cases.Conclusion:Certain CT dynamic changes,clinical and laboratory manifestations are characteristic of COVID-19.A deeper understanding of them will make up for the false negative of virus nucleic acid test,so that patients can be early isolated and intervened.

关 键 词：新型冠状病毒 肺炎 体层摄影术 X线计算机 

分 类 号：R445.4[医药卫生—影像医学与核医学]