双相CT空气潴留征与半定量评分预测新型冠状病毒肺炎患者血气指标异常及进展为重症的价值  

Predictive value of biphasic CT air trapping sign and semi-quantitative score in predicting abnormal blood gas index and progression to severe disease in COVID-19 patients

作　　者：周立娟 林晓明 毛海霞 鲍亚星 张士良 陈宏伟 高全胜 顾岚 方向明 Zhou Lijuan;Lin Xiaoming;Mao Haixia;Bao Yaxing;Zhang Shiliang;Chen Hongwei;Gao Quansheng;Gu Lan;Fang Xiangming(Department of Radiology,the Affiliated Wuxi People′s Hospital of Nanjing Medical University,Wuxi 214023,China;Department of Radiology,the Fifth People′s Hospital of Wuxi,Wuxi Infectious Disease Hospital,Wuxi 214007,China;Academy of Military Medicine,Chinese People′s Liberation Army Academy of Military Sciences,Beijing 100039,China)

机构地区：[1]南京医科大学附属无锡人民医院影像科,无锡214023 [2]无锡市第五人民医院,无锡市传染病医院影像科,无锡214007 [3]解放军军事科学院军事医学研究院,北京100039

出　　处：《中华放射学杂志》2022年第3期241-247,共7页Chinese Journal of Radiology

基　　金：国家自然科学基金(62041602);江苏省无锡市新型冠状病毒感染应急防治科技专项(N2020X005)。

摘　　要：目的探讨低剂量双相(吸气相与呼气相)CT空气潴留征及病灶范围半定量评分预测新型冠状病毒肺炎(COVID-19)患者重症及血气指标异常的价值。方法前瞻性连续性纳入2020年1月23日至2月29日无锡市定点收治医院经核酸检测确诊并住院治疗的非重症COVID-19患者。所有患者入院时均接受低剂量双相CT检查且在病程中按时接受CT复查。对入院吸气相CT上病变范围进行半定量评分并观察双相CT上出现的空气潴留征,采用独立样本t检验或χ_(2)检验分析半定量评分、空气潴留征及其他临床因素在血气指标异常与正常患者、进展为重症与未进展为重症患者的差异。采用受试者操作特征曲线下面积(AUC)、综合判别改善指数(IDI)评估半定量评分、空气潴留征及两者联合区分COVID-19患者血气指标异常与正常、进展为重症与未进展为重症患者的效能。结果纳入51例非重症COVID-19患者,在入院首次双相CT检查中16例患者出现空气潴留征。在病程中,13例出现血气指标异常(13/51),其中9例有空气潴留征(9/13);7例病情进展为重症(7/51),均有空气潴留征(7/7)。高龄、有空气潴留征、半定量评分较大的COVID-19患者出现血气指标异常的可能性更大(t=3.10、χ^(2)=9.38、t=3.34,P<0.05),高龄、有基础疾病史、有空气潴留征、半定量评分较大的COVID-19患者进展为重症的可能性更大(t=2.68、χ^(2)=6.65、χ^(2)=4.25、t=4.33,P<0.05)。半定量评分、空气潴留征及空气潴留征联合半定量评分区分血气指标异常与正常的AUC分别为0.803、0.754及0.794,区分COVID-19患者进展为重症与未进展为重症的AUC分别为0.881、0.898及0.932。空气潴留征联合半定量评分与单独半定量评分或空气潴留征相比,可以显著改善重症的预测(IDI=0.271、0.117)。结论空气潴留征和半定量评分可以作为预判COVID-19病情进展的有效指标,两者联合更有助于预测重症的发�Objective To explore the predictive value of low-dose biphasic(inspiratory and expiratory)CT air trapping sign and semi-quantitative score in predicting abnormal blood gas parameters and progression to severe disease in COVID-19 patients.Methods Patients with non-severe COVID-19 who were diagnosed by nucleic acid testing and hospitalized in designated hospitals in Wuxi City from January 23 to February 29,2020 were prospectively and consecutively recruited.All patients received low-dose biphasic CT examination on admission and repeated CT examination at regular intervals during the course.On the inspiratory phase admission of the bipolar CT,the scope of the lesion was evaluated by semi-quantitative score,and the air trapping sign on bipolar CT was assessed.The differences of semi-quantitative score,the presence of the air trapping sign and other clinical factors were compared between the patients with abnormal and the normal blood gas index,as well as between the cases progressed to severe disease and cases without disease progression using the independent sample t-test or χ^(2) test.The area under the curve(AUC)of receiver operating characteristic(ROC)and the comprehensive discriminant improvement index(IDI)were used to evaluate the predictive effectiveness of the semi-quantitative scores,air trapping sign,and combination of two factors in differentiating cases with abnormal and normal blood gas indexes,as well as in differentiating cases with and without disease progression to severe COVID-19 cases.Results In total 51 non-severe COVID-19 cases were included,with 16 cases showed air trapping sign during the first biphasic CT examination on admission.During the course of the disease,there were 13 patients with abnormal blood gas index,and 9 cases displaying air trapping sign(9/13).All 7 cases with progression to severe cases showed air trapping sign(7/7).Patients with advanced age,air trapping sign and higher semi-quantitative score were found more likely to have abnormal blood gas index(t=3.10,χ^(2)=9.38,t=3.34

关 键 词：体层摄影术 X线计算机 新型冠状病毒肺炎 空气潴留征 半定量 

分 类 号：R563.1[医药卫生—呼吸系统] R816.4[医药卫生—内科学]