肺CT在急诊发热门诊鉴别2019冠状病毒病中的价值  

The value of pulmonary CT in the identification of 2019 corona virus disease at emergency fever clinic

作　　者：尹路 戴佳原[1] 万霞[3] 王雪威[3] 王静怡 朱华栋[1] 于学忠[1] 徐军[1] Yin-lu;Dai Jia-yuan;Wan Xia;Wan Xue-wei;Wang Jing-yi;Zhu Hua-dong;Yu Xue-zhong;Xu Jun(Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院急诊科,北京100730 [2]安徽医科大学第二附属医院重症医学科,安徽合肥230601 [3]中国医学科学院基础医学研究所北京协和医学院基础学院,北京100730

出　　处：《中国急救医学》2020年第4期291-295,共5页Chinese Journal of Critical Care Medicine

基　　金：中国医学科学院医学与健康科技创新工程项目(2017-12M-1-009)。

摘　　要：目的研究肺CT在急诊发热门诊鉴别2019冠状病毒病(COVID-19)中的价值.方法回顾性收集2020年1月21日至2月10日在北京协和医院发热门诊筛查发现肺CT异常患者的临床资料,根据病原学证据将患者分为COVID-19组和非COVID-19组,分析比较两组患者的临床特点及影像学表现.结果共纳入肺CT异常患者35例,其中COVID-19患者15例,占同期发现全部17例COVID-19患者的88.2%.非COVID-19患者20例,两组在年龄、性别、基础疾病等人口学特征方面比较差异无统计学意义.COVID-19组有明确流行病学史的患者比例要远高于非COVID-19组(86.7%vs.10.0%,P<0.05),且COVID-19组有9例患者聚集性发病.COVID-19组与非COVID-19组发病时间均较短,两组比较差异无统计学意义[d:4(3,7)vs.2(1,4),P>0.05].COVID-19组与非COVID-19组大多数患者有发热,两组比较差异无统计学意义(86.7%vs.95.0%,P>0.05),多数有咳嗽两组比较差异无统计学意义(60.0%vS.65.0%,P>0.05),COVID-19组中少数患者有畏寒,发生率低于非COVID-19组(33.3%vs.75.0%,P>0.05).COVID-19组淋巴细胞正常,较非COVID-19组稍高[×109/L:1.5(1.2,1.7)vs.1.1(0.9,1.3),P<0.05].两组超敏C反应蛋白均升高,但差异无统计学意义[mg/L:16(3,26)vs.7.7(6,80.8),P>0.05].胸部X线检查对两组异常病变的检出率均低,组间比较差异无统计学意义(33.3%vs.20.0%,P<0.05).COVID-19组肺CT异常表现多见双侧、多发、胸膜下的磨玻璃影,其中仅胸膜下病变的发生率明显高于非COVID-19组(86.7%vs.45.0%,P<0.05).结论COVID-19早期多有肺CT异常表现,但胸部X线检查难以检出.在筛查出肺CT异常的患者中,仅凭肺CT表现鉴别COVID-19存在风险,明确流行病学史,尤其是聚集性发病及CT表现为胸膜下病变提示COVID-19可能性较大.Objective To investigate the value of pulmonary CT in the identification 2019 coronavirus disease(COVID-19)at emergency fever clinic.Methods From January 21 to February 10,2020 the clinical data of patients with abnormal pulmonary CT were collected and analyzed retrospectively.Based on the evidence of pathogens,the patients were divided into the COVID-19 group and the group without COVID-19.The clinical characteristics and imaging findings between the two groups were compared.Results A total of 35 patients with abnormalities in pulmonary CT were enrolled,there were 15 patients with COVID-19,accounted for 88.2%of all 17 patients with COVID-19 found in the same period.There were 20 patients without COVID-19.No significant differences were found in age,gender,basic diseases and other demographic characteristics between the two groups.The proportion of patients with definite epidemiological history in the COVID-19 group was much higher than that in the group without COVID-19(86.7%vs.10.0%,P<0.05),and there were 9 clustering cases in the COVID-19 group.The onset times in both the COVID-19 group and the group without COVID-19 were short and no significant difference existed between them[days:4(3,7)vs.2(1,4),P>0.05].In the two groups,most of the patients had fever and no significant difference existed between them(86.7%vs.95.0%,P>0.05),more patients had cough and no significant difference existed between them(60.0%vs.65.0%,P>0.05).A few patients in the COVID-19 group had chills and the incidence was lower than in the group without COVID-19(33.3%vs.75.0%,P<0.05).The lymphocyte count of COVID-19 group was normal,and higher than that of the group without COVID-19[x IOVL:1.5(1.2,1.7)vs.1.1(0.9,1.3),P<0.05)].The high-sensitivity C-reactive protein increased in both groups but no significant difference existed[m g/L:16(3,26)vs.7.7(6,80.8),P>0.05].The detection rate of abnormal lesions using chest X-ray was low in both groups,no significant difference existed between them(33.3%vs.20.0%,P>0.05).The pulmonary CT abnormalities in

关 键 词：2019冠状病毒病 感染 肺 CT 

分 类 号：R816.4[医药卫生—放射医学] R563.1[医药卫生—临床医学]