输入性新型冠状病毒肺炎首诊影像学特点与临床严重度分级的相关性  

The Correlation between the Imaging Characteristics of Imported COVID-19 at First Diagnosis and Clinical Severity Grading

作　　者：吴莉[1] 杨云辉[2] 张靖[3] 杨章聪 苏宇 温勇坚 吴玉春 王鹏[8] 李志鹏 赵卫[1] 韩丹[1] 王瑞东 何波[1] WU Li;YANG Yun-hui;ZHANG Jing;YANG Zhang-cong;SU Yu;WEN Yong-jian;WU Yu-chun;WANG Peng;LI Zhi-peng;ZHAO Wei;HAN Dan;WANG Rui-dong;HE Bo(Dept.of Medical Imaging,The 1st Affiliated Hospital of Kunming Medical University,Kunming Yunnan 650032;Dept.of Medical Imaging,People’s Hospital of Xishuangbanna Dai Autonomous Prefecture,Xishuangbanna Yunnan 666100;CT Room,People’s Hospital of Yuxi,Yuxi Yunnan 653100;Dept.of Medical Imaging,Weixin County People’s Hospital,Weixin Yunnan 657900;Dept.of Radiology NO.1,People’s Hospital of Dali City,Dali Yunnan 671000;Dept.of Radiology,the Third People’s Hospital of Yunnan Province,Kunming Yunnan 650011;Dept.of Medical Imaging,The First People’s Hospital of Xundian County,Xundian Yunnan 655200;Dept.of Radiology,Yunnan Second People’s Hospital,Kunming Yunnan 650021;Dept.of Medical Imaging,Yunnan Infectious Hospital/Yunnan AIDS Care Center,Kunming Yunnan 650300,China)

机构地区：[1]昆明医科大学第一附属医院医学影像科,云南昆明650032 [2]西双版纳州人民医院医学影像科,云南西双版纳666100 [3]玉溪市人民医院CT室,云南玉溪653100 [4]威信县人民医院医学影像科,云南威信657900 [5]大理市第一人民医院放射影像科,云南大理671000 [6]云南省第三人民医院放射科,云南昆明650011 [7]寻甸县第一人民医院医学影像科,云南寻甸655200 [8]云南省第二人民医院放射科,云南昆明650021 [9]云南省传染医院/云南省艾滋病关爱中心医学影像科,云南昆明650300

出　　处：《昆明医科大学学报》2021年第7期49-56,共8页Journal of Kunming Medical University

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项基金资助项目(202001AVY070001-029,202001AVY070001-038)。

摘　　要：目的探讨输入性新型冠状病毒肺炎(COVID-19)首诊影像学特点与临床严重度分级的相关性。方法回顾性分析2020年1月21日至2020年2月25日云南省经核酸检测确诊116例输入性COVID-19病例(年龄范围为5~84岁,男59例,女57例)的临床及影像资料。比较不同临床分型(轻型、普通型、重型、危重型)患者的临床资料、实验室检查、影像学特征的差异。结果116例输入型患者中,不同年龄组间患病差异有统计学意义(χ^(2)=19.589,P=0.006),21~55岁患病率较高,占44.83%(55/116),51~70岁者患重症肺炎(6/42,14.29%)较21~50岁3/52(5.17%)高(P<0.05);发热/畏寒(70.8%)及呼吸道症状(58.4%)是新冠肺炎最常见首诊症状。本组病例从症状出现至第1次CT扫描时间平均为(4.17±1.12)d,时间越长,临床分型越重(F=2.688,P=0.049);不同临床分型白细胞总数、淋巴细胞总数、淋巴细胞百分比、乳酸脱氢酶(LDH)、C反应蛋白差异有统计学意义(F=3.486,3.640,5.154,15.361,8.195,P均<0.05);重型、危重型淋巴细胞总数及淋巴细胞百分比较轻型与普通型明显降低(P<0.05)。116例共383个病灶,总累及范围平均评分为(4.17±2.12)分,普通型较危重型累及范围小(F=62.137,P=0.000);病灶多累及双侧肺,约占70/116(78.26%),下叶85/116(37.12%)较中叶70/116(30.13%)、上叶75/116(32.75%)多见(χ^(2)=10.190,P=0.021),胸膜下区87/229(57.24%)较肺门区29/229(19.08%)、肺中带36/229(23.68%)多见(χ^(2)=5.187,P=0.018);圆形、椭圆形病灶多见(χ^(2)=43.922,P=0.000),其中带状及盘状病变以重型、危重型患者多见(P<0.05);不同类型患者病变特点不同(χ^(2)=50.974,P=0.000),其中GGO内血管增粗发生率最高,约占19.58%。单纯GGO、PS、混合密度影、支气管充气征及晕征普通型较重型多见(P<0.05),GGO伴支气管壁增厚、纤维索条、支气管变形以重型、危重型多见(P<0.05);伴随病变中以胸膜增厚为最多见(χ^(2)=42.119,P=0.000)。结论不同临床分型的输入�Objective To investigate the correlation between the imaging characteristics of the first diagnosis of imported novel coronavirus pneumonia(COVID-19)and clinical severity grading.Methods A retrospective analysis was performed on the clinical and imaging data of 116 imported COVID-19 cases(aged 5~84 years,59 males and 57 females)confirmed by nucleic acid test on January 21,2020(solstice,February 25,2020)in Yunnan province.Differences in clinical data,laboratory examination and imaging characteristics of patients with different clinical types(light,normal,heavy and critical)were compared.Fisher’s exact probability method was used for comparison of measurement data,z-test was used for comparison of ppairs,analysis of variance was used for comparison of quantitative data,and mann-whitney test was used for comparison of ppairs.Results There was no statistically significant difference in prevalence between male and female patients with 116 cases input COVID-19(χ^(2)=1.288,P=0.808);There were statistically significant differences among different age groups(χ^(2)=19.589,P=0.006),The prevalence of 21-55 years old is high,about 44.83%(55/116),the second is 51 to 70 years old,about 36.21%(42/116),Severe pneumonia(6/42,14.29%)was higher in patients aged from 51 to 70 than in patients aged 21 to 50(3/52)(5.17%)(P<0.05).;Fever/chills(70.8%)and respiratory symptoms(58.4%)were the most common initial symptoms of new crown pneumonia.The average time from symptom onset to the first CT scan was 4.17±1.12 days.The longer the time,the heavier the clinical classification(F=2.688,P=0.049).The differences in total number of leukocytes,total number of lymphocytes,percentage of lymphocytes,lactate dehydrogenase(LDH)and c-reactive protein in different clinical classifications were statistically significant(F=3.486,3.640,5.154,15.361,8.195,all P<0.05).The total number and percentage of lymphocytes of the severe and critical types were significantly lower than that of the light and normal types(P<0.05).There were 383 lesions in 116 pati

关 键 词：输入性新型冠状病毒肺炎 影像表现 临床分级 

分 类 号：R816.41[医药卫生—放射医学]