新型冠状病毒肺炎患者肺CT评分的时空分布及预测价值  

Spatial and temporal distribution and predictive value of chest CT scoring in patients with COVID-19

作　　者：李姝[1] 刘韶瑜[1] 赵宇晴[2] 李秋钰 刘东阳 刘志成 李大胜[6] 曾琳[7] 葛庆岗[8] 马青变[1] 沈宁[3] Li Shu;Liu Shaoyu;Zhao Yuqing;Li Qiuyu;Liu Dongyang;Liu Zhicheng;Li Dasheng;Zeng Lin;Ge Qinggang;Ma Qingbian;Shen Ning(Department of Emergency Medicine,Peking University Third Hospital,Beijing 100191,China;Department of Radiology,Peking University Third Hospital,Beijing 100191,China;Department of Pulmonary and Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China;Drug Clinical Trial Center of Peking University Third Hospital,Beijing 100191,China;Department of Pulmonary and Critical Care Medicine,the First Affiliated Hospital of Nanchang University,Nanchang 330006,China;Department of Radiology,Beijing Haidian Hospital,Beijing 100080,China;Clinical Epidemiology Research Center,Peking University Third Hospital,Beijing 100191,China;Department of Critical Care Medicine,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院急诊科,100191 [2]北京大学第三医院放射科,100191 [3]北京大学第三医院呼吸与危重医学科,100191 [4]北京大学第三医院药物临床试验机构,100191 [5]南昌大学第一附属医院呼吸与危重医学科,330006 [6]北京市海淀医院放射科(北京大学第三医院海淀院区),100080 [7]北京大学第三医院临床流行病学中心,100191 [8]北京大学第三医院危重医学科,100191

出　　处：《中华结核和呼吸杂志》2021年第3期230-236,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：国家重点研发计划(2018YFC1311900);中央高校基本科研业务费专项资金北京大学疫情防控公关专项(BMU2020HKYZX011)。

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)患者CT评分及其预测价值。方法回顾性分析2020年1月27日至3月8日确诊的3个临床中心的197例COVID-19患者的临床及影像资料,患者中位年龄64岁,54.8%为男性。由两位临床医师进行CT评分。两侧肺野以气管隆凸水平和下肺静脉水平分为共6个区域。目标病变类型为磨玻璃影、肺实变、总体病变范围及是否存在铺路石征。结果197例COVID-19患者共纳入可分析的CT图像522个。从第2周开始,重型及危重型患者各类病变CT评分均高于普通型患者。第5周以后病程进入恢复期。上肺区域CT评分低于其他区域。入院分级为普通型的患者,病程第2周的磨玻璃影评分对于住院期间严重程度分级的升级具有预测价值,其受试者工作特征曲线下面积0.849,最佳截断值为5分,敏感度84.2%,特异度75.0%。结论由临床医师使用CT评分对新型冠状病毒肺炎患者进行评估具有可行性。病程第2周磨玻璃影评分对普通型患者住院期间病情恶化具有预测价值。恢复期可酌情降低复查CT频率。Objective To explore a modified CT scoring system,its feasibility for disease severity evaluation and its predictive value in coronavirus disease 2019(COVID-19)patients.Methods This study was a multi-center retrospective cohort study.Patients confirmed with COVID-19 were recruited in three medical centers located in Beijing,Wuhan and Nanchang from January 27,2020 to March 8,2020.Demographics,clinical data,and CT images were collected.CT were analyzed by two emergency physicians of more than ten years′work experience independently through a modified scoring system.Final score was determined by average score from the two reviewers if consensus was not reached.The lung was divided into 6 zones(upper,middle,and lower on both sides)by the level of trachea carina and the level of lower pulmonary veins.The target lesion types included ground-glass opacity(GGO),consolidation,overall lung involvement,and crazy-paving pattern.Bronchiectasis,cavity,pleural effusion,etc.,were not included in CT reading and analysis because of low incidence.The reviewers evaluated the extent of the targeted patterns(GGO,consolidation)and overall affected lung parenchyma for each zone,using Likert scale,ranging from 0-4(0=absent;1=1%-25%;2=26%-50%;3=51%-75%;4=76%-100%).Thus,GGO score,consolidation score,and overall lung involvement score were sum of 6 zones ranging from 0-24.For crazy-paving pattern,it was only coded as absent or present(0 or 1)for each zone and therefore ranging from 0-6.Results A total of 197 patients from 3 medical centers and 522 CT scans entered final analysis.The median age of the patients was 64 years,and 54.8%were male.There were 76(38.8%)patients had hypertension and 30(15.3%)patients had diabetes mellitus.There were 75 of the patients classified as moderate cases,as well as 95 severe cases and 27 critical cases.As initial symptom,dry cough occurred in 170 patients,134 patients had fever,and 125 patients had dyspnea.Reparatory rate,oxygen saturation,lymphocyte count and CURB 65 score on admission day varied among pa

关 键 词：新型冠状病毒肺炎 体层摄影术 肺炎 病毒性 

分 类 号：R563.1[医药卫生—呼吸系统] R816.41[医药卫生—内科学]