新型冠状病毒肺炎疑似患者274例的筛检方案评估  

Study on screening for 274 suspected cases of corona virus disease 2019

作　　者：杨旭丽[1] 王志慧[1] 刘星 伍姗姗[1] 邬小萍[2] 温桂兰[3] 曾献军[4] 熊华威[5] 刘杰[6] 洪涛[7] Yang Xuli;Wang Zhihui;Liu Xing;Wu Shanshan;Wu Xiaoping;Wen Guilan;Zeng Xianjun;Xiong Huawei;Liu Jie;Hong Tao(Quality Control Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China;Infectious Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China;Respiratory and Critical Medicine Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China;Radiology Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China;Emergency Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China;Department of Chronic Non-communicable Disease Control and Prevention,Jiangxi Province Center for Disease Control and Prevention,Nanchang 330029,China;Neurosurgery Department,the First Affiliated Hospital of Nanchang University,Jiangxi Province 330006,China)

机构地区：[1]南昌大学第一附属医院质控科,330006 [2]南昌大学第一附属医院感染科,330006 [3]南昌大学第一附属医院呼吸与危重症医学科,330006 [4]南昌大学第一附属医院影像科,330006 [5]南昌大学第一附属医院急诊科,330006 [6]江西省疾病预防控制中心慢性非传染性疾病防制所,南昌330029 [7]南昌大学第一附属医院神经外科,330006

出　　处：《中华传染病杂志》2020年第4期199-203,共5页Chinese Journal of Infectious Diseases

摘　　要：目的分别评价胸部计算机断层成像(computed tomography,CT)检查、临床表现和2019新型冠状病毒(2019 novel coronavirus,2019-nCoV)核酸检测在筛查及诊断新型冠状病毒肺炎中的效能和价值。方法收集2020年1月23日至2月9日南昌大学第一附属医院发热门诊考虑疑似新型冠状病毒肺炎并提请会诊或收住急诊留观室的所有患者的临床资料,其中274例符合纳入标准。设计4种筛检方案(胸部CT检查筛检法、评分法、胸部CT检查和评分串联筛检法、胸部CT检查和评分并联筛检法),并比对其诊断效能。统计学分析采用χ^2检验,并检测各筛检方案的灵敏度、特异度和受试者操作特征曲线下面积。结果274例患者中,93.80%(257/274)有典型临床症状,47.81%(131/274)有流行病学史,45.26%(124/274)血常规检查结果符合评分法中的阳性标准,43.07%(118/274)胸部CT检查结果符合胸部CT检查筛检法中的阳性标准。有流行病学史的患者2019-nCoV核酸检测阳性率为30.53%(40/131),高于无流行病学史的9.09%(13/143);胸部CT检查有典型影像学表现的患者2019-nCoV核酸检测阳性率为40.68%(48/118),高于无典型影像学表现的3.21%(5/156);差异均有统计学意义(χ^2=20.150、60.468,均P<0.01)。胸部CT检查筛检法、评分法、串联筛检法、并联筛检法的各阳性组,其2019-nCoV核酸检测的阳性率分别为40.68%(48/118)、23.74%(47/198)、44.68%(42/94)和23.87%(53/222),而各阴性组的核酸阳性率分别为3.21%(5/156)、7.89%(6/76)、6.11%(11/180)和0(0/52)。将4种筛检方案阳性率分别与"单一核酸检测阳性率"比较,差异均有统计学意义(κ=0.402、0.100、0.431、0.106,均P<0.01)。胸部CT检查筛检法的灵敏度为90.57%,特异度为68.33%,受试者操作特征曲线下面积为0.794,其诊断效能高于其他3种筛检方案。结论对于新型冠状病毒肺炎病例的筛查和诊断,有流行病学史、2019-nCoV核酸检测呈阳性,结合≥2项的典型临床表现Objective To evaluate the diagnostic efficacies of computed tomography(CT),clinical manifestations and 2019 novel coronavirus(2019-nCoV)nucleic acid test results for the screening and diagnosis of novel coronavirus pneumonia.Methods The clinical data of suspected cases with corona virus disease 2019(COVID-19)visited fever clinic or stayed in emergency room of the First Affiliated Hospital of Nanchang University from January 23 to February 9,2020 were collected.Totally 274 cases who met the inclusion criteria were enrolled.Four screening schemes including chest CT screening,scoring,chest CT and scoring series screening,chest CT and scoring parallel screening were designed.The statistical analysis was performed by using chi-square test.The sensitivities,specificities and the areas under the receiver operator characteristic curve of the four screening schemes were calculated,and the diagnostic efficacies were evaluated.Results Among the 274 cases,93.80%(257/274)presented with typical clinical symptoms,47.81%(131/274)had epidemiological history,and the blood routine examination results of 45.26%(124/274)cases met the positive criteria of the scoring,and chest CT results of 43.07%(118/274)cases met the positive criteria of chest CT screening.The 2019-nCoV nucleic acid test positive rate of cases with epidemiological history was 30.53%(40/131),which was higher than that of cases without epidemiological history(9.09%(13/143)),and that of cases with typical imaging performance on chest CT was 40.68%(48/118),which was higher than cases without typical imaging performance(3.21%(5/156)).The differences between the above groups were both statistically significant(χ^2=20.150、60.468,respectively,both P<0.01).The positive rates of viral nucleic acid detection in cases with positive findings of chest CT screening,scoring,series screening,and parallel screening were 40.68%(48/118),23.74%(47/198),44.68%(42/94)and 23.87%(53/222),respectively,while those in cases with negative findings of the four screening schemes were 3.20%(5/1

关 键 词：冠状病毒感染 肺炎 新型冠状病毒肺炎 胸部计算机断层成像 实时聚合酶链反应 筛检 

分 类 号：R512.99[医药卫生—内科学] R563.1[医药卫生—临床医学]