新型冠状病毒感染患者胸部CT模式定量分析与临床特征的相关性  

Quantitative analysis of chest CT in coronavirus infected patients and its correlation with clinical features

作　　者：王岩[1] 李姣 曲彦[1,2] 王素梅 Wang Yan;Li Jiao;Qu Yan;Wang Sumei(Department of Critical Care Medicine,Qingdao Municipal Hospital,Qingdao 266001,Shandong,China;Department of Medical Institution,Qingdao University,Qingdao 266001,Shandong,China)

机构地区：[1]青岛市市立医院重症医学科,山东青岛266001 [2]青岛大学医学部,山东青岛266001

出　　处：《中华危重病急救医学》2024年第12期1238-1243,共6页Chinese Critical Care Medicine

基　　金：山东省医药卫生科技项目(202319010379)。

摘　　要：目的探索新型冠状病毒(新冠病毒)感染患者胸部计算机断层扫描(CT)不同模式的定量分析结果及其与病毒载量和病理生理状态的关系。方法采用回顾性临床队列观察研究,选择2023年6月9日至15日在青岛市市立医院就诊的新冠病毒感染患者(所有患者均在确诊后24 h内接受胸部CT检查),根据CT表现将患者分为新冠病毒感染非肺炎组和新冠病毒感染相关性肺炎组。收集各组患者的相关基线数据,如人口学特征、胸部CT特征、CT检查前后12 h内的实验室指标等资料。采用Spearman相关性检验定量分析CT特征与实验室指标之间的相关性;绘制受试者工作特征曲线(ROC曲线)评估各实验室指标对新冠病毒感染患者发生肺炎的预测价值;采用多元线性回归分析探讨磨玻璃影(GGO)和实变等不同CT模式与通气氧合状态之间的关系。结果最终纳入171例新冠病毒感染患者,其中新冠病毒感染非肺炎组44例,新冠病毒感染相关性肺炎组127例(肺炎发病率为74.3%)。与单纯新冠病毒感染患者相比,新冠病毒感染相关性肺炎患者的淋巴细胞计数(LYM)、氧合指数(PaO_(2)/FiO_(2))、肺总量、GGO体积和GGO比例明显更低,C-反应蛋白(CRP)、中性粒细胞/淋巴细胞比值(NLR)、D-二聚体、吸入氧浓度(FiO_(2))水平、实变体积和实变比例明显更高,差异均有统计学意义;两组间核衣壳蛋白(N)基因循环阈值(Ct)、开放阅读框(ORF)基因Ct值比较差异均无统计学意义。ROC曲线分析显示,经年龄、性别、CRP水平等相关因素校正后,与N基因Ct值、ORF基因Ct值、N基因Ct值+LYM、ORF基因Ct值+LYM相比,LYM预测新冠病毒感染相关性肺炎的效能最强,ROC曲线下面积(AUC)为0.703;当LYM截断值为0.7×10^(9)/L时,敏感度为55.5%,特异度为79.5%。多元线性回归分析显示,当根据实变比例、年龄、性别、Hb和D-二聚体水平进行校正时,新冠病毒感染相关性肺炎患者的GGO比例�Objective To explore the quantitative analysis results of different patterns of chest computed tomography(CT)in patients with coronavirus infection and its relationship with viral load and pathophysiological status.Methods A retrospective clinical cohort study was conducted.Patients with coronavirus infection admitted to Qingdao Municipal Hospital from June 9 to 15,2023(all patients underwent chest CT examination within 24 hours after diagnosis)were enrolled.The patients were divided into coronavirus infection non-pneumonia group and coronavirus infection associated pneumonia group according to CT findings.Relevant baseline data,such as demographic characteristics,chest CT characteristics,and laboratory indicators within 12 hours before and after CT examination were collected from each group.Spearman correlation test was used to quantitatively analyze the correlation between CT features and laboratory indicators.The receiver operator characteristic curve(ROC curve)was drawn to evaluate the predictive value of each laboratory index for pneumonia in patients infected with coronavirus.Multiple linear regression analysis was used to explore the relationship between different CT patterns such as ground-glass opacity(GGO)and consolidation and ventilatory oxygenation status.Results A total of 171 patients were enrolled,including 44 patients in the coronavirus infection non-pneumonia group and 127 patients in the coronavirus infection associated pneumonia group(the incidence of pneumonia was 74.3%).Compared with patients with coronavirus infection alone,patients with coronavirus infection associated pneumonia had significantly lower lymphocyte count(LYM),oxygenation index(PaO_(2)/FiO_(2)),total lung capacity,GGO volume and GGO ratio,and significantly higher C-reactive protein(CRP),neutrophil/lymphocyte ratio(NLR),D-dimer,fraction of inspired oxygen(FiO_(2))level,real volume variation and consolidation ratio,the differences were all statistically significant.There were no statistically significant differences in the nucle

关 键 词：定量CT分析 新型冠状病毒感染 磨玻璃影 实变 氧合指数 

分 类 号：R511[医药卫生—内科学] R816.4[医药卫生—临床医学]