发热门诊首诊胸部X线摄影对不同年龄、性别临床可疑COVID-19病人的诊断价值  

Clinical value of chest radiography in the initial diagnosis of suspected COVID-19 patients in different age and sex from fever clinics

作　　者：许丽雪 吕晗[1] 陈疆红[1] 王振常[1] 杨正汉[1] XU Lixue;LüHan;CHEN Jianghong;WANG Zhenchang;YANG Zhenghan(Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050

出　　处：《国际医学放射学杂志》2020年第5期505-508,共4页International Journal of Medical Radiology

基　　金：国家自然科学基金专项项目(62041103);北京市科技计划项目(Z201100005420013);中国博士后科学基金新冠肺炎疫情防控专项资助(2020T130083ZX)。

摘　　要：目的探讨发热门诊首诊胸部X线摄影对临床可疑新型冠状病毒肺炎(COVID-19)病人相关肺内病变的诊断价值,并分析X线摄影与CT对不同年龄、性别病人肺内相关病变的识别能力。方法回顾性分析北京新冠肺炎全病程信息与样本资源管理平台“新冠肺炎影像专题库”中临床可疑COVID-19病人首诊胸部影像学资料,纳入39家医院共607例病人,男340例,女267例,平均年龄(48.4±22.2)岁。其中,首诊X线摄影检查170例,首诊CT检查437例。以RT-PCR检测结果为参考标准,分析X线摄影与CT对COVID-19相关肺内病变的诊断能力,采用Z检验比较2种检查方法的曲线下面积(AUC)。计算2种检查方法对不同性别、年龄病人的诊断准确度、误诊率与漏诊率,并采用χ2检验或Kruskal-Wallis检验比较2种检查方法的诊断结果。结果X线摄影与CT对临床可疑COVID-19病人肺内病变的诊断敏感度、特异度、阴性预测值、AUC差异均无统计学意义(均P>0.05),但X线的阳性预测值低于CT(P<0.05)。对于男性病人,2种检查方法诊断能力差异无统计学意义(P>0.05);对于女性病人,X线摄影的诊断准确度低于CT(P<0.05),误诊率高于CT(P<0.05)。2种检查方法对男性病人的漏诊率均低于女性病人(均P<0.05)。X线对不同年龄病人诊断能力的差异无统计学意义(P>0.05);CT对不同年龄病人诊断准确度的差异存在统计学意义(P<0.05)。结论发热门诊首诊环节,胸部X线摄影与CT对不同年龄、性别临床可疑COVID-19病人肺内病变的诊断能力相近,CT对女性病人诊断准确度更高。两者诊断能力均有限,需结合病史、临床症状及实验室检查等信息以提高诊断效能。Objective To investigate the clinical value of chest radiography in the initial diagnosis of suspected COVID-19 patients,and analyze the diagnostic performance of chest radiography and CT in patients with different age and sex from fever clinics.Methods Based on Beijing COVID-19 information and resource management platform“COVID-19 image database”,the radiological data of 607 clinical suspected patients from 39 hospitals in Beijing were retrospectively analyzed.During the first visit to fever clinic,there were 340 males and 267 females,with an average age 48.4±22.2 years,including 170 patients underwent chest radiography and 437 patients underwent CT examinations.Taking results of RT-PCR as standard references,diagnostic performances of chest radiography and CT in detecting COVID-19 related lung abnormalities were analyzed.The Z test was used to compare group difference of the area under the curve(AUC)between the imaging methods.Diagnostic accuracy,overestimation ratio,and underestimation ratio of chest radiography and CT were calculated for patients in sex-and age-based subgroups.The Chi-square test or Kruskal-Wallis test was used to compare the diagnostic difference between chest radiography and CT.Results There was no significant group difference between chest radiography and CT in sensitivity,specificity,negative predictive value and AUC(all P>0.05).However,the positive predictive value of radiography was significantly lower than that of CT(P<0.05).For men,there was no significant groupdifference in diagnostic performance between chest radiography and CT(P>0.05).For women,the diagnostic accuracy(P<0.05)of chest radiography was significantly lower while its overestimation ratio(P<0.05)was significantly higher than that of CT.The underestimation ratio in men was lower than that in women for radiography(P<0.05)and CT(P<0.05).For chest radiography,there were no significant differences in diagnostic performance among the age-based subgroups(P>0.05).There was significant difference in accuracy was observed for

关 键 词：新型冠状病毒肺炎 X线摄影 体层摄影术 X线计算机 发热门诊 

分 类 号：R445.4[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]