疫情流行期间心力衰竭与新型冠状病毒肺炎患者临床及影像学特征的比较  

Comparison of heart failure and COVID-19 in chest CT features and clinical characteristics

作　　者：朱兆伟 唐建军[1] 柴湘平[2] 方臻飞[1] 刘启明[1] 胡信群[1] 许丹焰[1] 唐亮[1] 台适[1] 伍玉枝[3] 周胜华[1] Zhu Zhaowei;Tang Jianjun;Chai Xiangping;Fang Zhenfei;Liu Qiming;Hu Xinqun;Xu Danyan;Tang Liang;Tai Shi;Wu Yuzhi;Zhou Shenghua(Department of Cardiology,Second Xiangya Hospital of Central South University,Changsha 410011,China;Emergency Depratment,Second Xiangya Hospital of Central South University,Changsha 410011,China;Department of Radiology,Second Xiangya Hospital of Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心内科,长沙410011 [2]中南大学湘雅二医院急诊科,长沙410011 [3]中南大学湘雅二医院放射科,长沙410011

出　　处：《中华心血管病杂志》2020年第6期467-471,共5页Chinese Journal of Cardiology

摘　　要：目的对比心力衰竭及新型冠状病毒肺炎(COVID-19)患者临床及肺部影像学特征,总结二者的鉴别要点。方法本研究为回顾性研究。纳入中南大学湘雅二医院于2019年12月1日至2020年2月15日间收治的心力衰竭及COVID-19患者,排除病例资料不全者,共纳入心力衰竭患者7例,COVID-19患者12例。比较两组的基线临床特征(包括性别、年龄、病史、实验室检查等)及肺部CT影像学特征。结果两组间年龄、性别差异无统计学意义(P均>0.05),COVID-19组流行病学接触史、发热或呼吸道症状比例明显高于心力衰竭组(12/12比0,P<0.001;12/12比4/7,P=0.013);合并心血管基础疾病、心功能受损比例则明显少于心力衰竭组(2/12比7/7,P<0.001;0比7/7,P<0.001)。影像学方面,两组患者都可有磨玻璃影及小叶间隔增厚的特点。但与COVID-19组比较,心力衰竭患者肺部病变呈中央型及阶梯状的比例(4/7比1/12,P=0.04)及小肺静脉扩张比例更高(3/7比0,P=0.013),且经有效抗心力衰竭治疗后肺部病变会快速改善。此外,COVID-19患者肺部病变呈圆形或类圆形的比例高于心力衰竭患者(9/12比2/7,P=0.048)。结论COVID-19患者具有流行病学接触史,发热和呼吸道症状明显。在肺部CT影像学表现上,二者有相似之处,但病变分布特点、病变形态和肺静脉扩张情况有不同之处。Objective To identify the characteristics including clinical features and pulmonary computed tomography(CT)features of heart failure and COVID-19.Methods This study was a retrospective study.A total of 7 patients with heart failure and 12 patients with COVID-19 in the Second Xiangya Hospital of Central South University between December 1,2019 and February 15,2020 were enrolled.The baseline clinical and imaging features of the two groups were statistically analyzed.Results There was no significant difference in age and sex between the two groups(both P>0.05),but the incidence of epidemiological contact history,fever or respiratory symptoms in the COVID-19 group was significantly higher than that in the heart failure group(12/12 vs.0,P<0.001;12/12 vs.4/7,P=0.013).While the proportion of cardiovascular diseases and impaired cardiac function was significantly less than that of the heart failure group(2/12 vs.7/7,P<0.001;0 vs.7/7,P<0.001).For imaging features,both groups had ground-glass opacity and thickening of interlobular septum,but the ratio of central and gradient distribution was higher in patients with heart failure than that in patients with COVID-19(4/7 vs.1/12,P=0.04).In heart failure group,the ratio of the expansion of pulmonary veins was also higher(3/7 vs.0,P=0.013),and the lung lesions can be significantly improved after effective anti-heart failure treatment.Besides,there were more cases with rounded morphology in COVID-19 group(9/12 vs.2/7,P=0.048).Conclusions More patients with COVID-19 have epidemiological history and fever or respiratory symptoms.There are significant differences in chest CT features,such as enlargement of pulmonary veins,lesions distribution and morphology between heart failure and COVID-19.

关 键 词：新型冠状病毒肺炎 心力衰竭 肺部CT 

分 类 号：R541.6[医药卫生—心血管疾病] R563.1[医药卫生—内科学]