| COVID-19患者的早期心脏损害表现及识别 |
| |
| 作者姓名： | 耿磊 左娟 孙毅 万金鑫 丁军明 赵妍 龚磊 汪秀玲 徐凯 |
| |
| 作者单位： | 1.汕头市中心医院（中山大学附属汕头医院）急诊科，广东 汕头 5150312.汕头市中心医院（中山大学附属汕头医院）泌尿外科，广东 汕头 5150313.汕头市中心医院（中山大学附属汕头医院）儿科，广东 汕头 5150314.汕头市中心医院（中山大学附属汕头医院）超声科，广东 汕头 5150315.汕头市中心医院（中山大学附属汕头医院）感染科，广东 汕头 515031 |
| |
| 基金项目： | 江苏大学临床医学科技发展基金JLY20180518 |
| |
| 摘 要： | 目的分析COVID-19合并早期心脏损害的临床表现及心脏损害早期识别的指标。方法收集2020年1月20日~2月20日我院收治的12例COVID-19患者的临床表现、实验室检查、心脏彩超等资料，心脏彩超主要收集左心室射血分数（LVEF）、左室总体纵向应变（GLS）。分析COVID-19早期心脏损害的发生情况，比较窦性心动过速、心电图新发改变、GLS作为COVID-19合并早期心脏损害表现的可能识别指标，并进一步分析COVID-19早期心脏损害的相关危险因素。结果12例COVID-19患者包括2例重型、8例普通型和2例轻型，所有患者肌钙蛋白Ⅰ、LVEF均无明显异常。但窦性心动过速、心电图新发改变及GLS的异常率均为33%，肌酸激酶同工酶与B型钠尿肽的异常率均为8%；COVID-19早期心脏损害可能指标GLS的绝对值与年龄、中性粒细胞比值、C-反应蛋白存在负相关（r=-0.795，-0.816，-0.917，P < 0.05），与血钾存在正相关性（r=0.73，P < 0.01）。结论窦性心动过速、心电图新发改变及GLS在COVID-19患者中存在一定的异常比例，可能作为早期心脏损害识别指标。在肌钙蛋白Ⅰ、LVEF未见异常的COVID-19，通过观察患者的心电图的是否存在窦速、新发异常改变、GLS的异常，有助于对COVID-19心脏损害的早期识别。
|
| 关 键 词： | COVID-19 早期心脏损害 左室总体纵向应变 心电图 |
| 收稿时间： | 2020-05-23 |
Typical and atypical HRCT manifestations of COVID-19 |
| |
| Authors: | Lei GENG Juan ZUO Yi SUN Jinxin WAN Junming DING Yan ZHAO Lei GONG Xiuling WANG Kai XU |
| |
| Affiliation: | 1.Department of Medical Imaging, the Second People's Hospital of Lianyungang, Lianyungang 222023, China2.Department of Ultrasound, the Fourth People's Hospital of Lianyungang, Lianyungang 222023, China3.Department of Medical Imaging, the Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, China |
| |
| Abstract: | ObjectiveTo explore the typical and atypical HRCT manifestations of novel coronavirus and its value in clinical diagnosis and treatment.MethodsThe chest HRCT manifestations of 28 COVID-19 patients diagnosed by clinical and nucleic acid testing were collected and analyzed. There were 16 males and 12 females, with age of 25-71 years(46±14.9 years). The distribution, range, shape and density of the lesion, the presence of lymph nodes in the mediastinum and hilum, and the presence of abnormalities in the thorax and pleura were analyzed. According to the 4-day interval between the first chest HRCT examination at the age of 50 and after fever, the age and time interval were divided into groups. The number of lung segments involved by COVID-19 in different groups was compared.ResultsTypical HRCT manifestations of COVID-19: Subpleural or multicentric distribution in 20 cases, single or multiple patchy or segmental ground glass density shadow (GGO) in 11 cases. GGO was associated with septal thickening in 14 cases, of which 5 showed typical "paving signs". Eight cases of solid change with GGO. Consolidation was observed in 5 cases with internal air bronchus. Atypical manifestations: 5 cases presented diffuse hyaline nodules in the center of lobule. In 5 cases, there were meshes and honeycomb fiber strip shadows. In 3 cases, the distribution was segmental around the bronchus. Pleural and mediastinal manifestations: pleural thickening in 1 case. There was no pleural effusion and lymph node enlargement in this group. Patients who underwent HRCT for the first time after fever at a time interval of more than 4 days involved more than 3 pulmonary segments (P=0.002). Patients over 50 years of age with more than 3 lung segments were more likely to be involved than patients under 50 years of age (P=0.003)ConclusionsThe chest HRCT manifestations of COVID-19 have certain characteristics, which not only become the main means of early screening and diagnosis of COVID-19, but also control and early treatment of highly suspected patients.It can evaluate the clinical course, severity, efficacy and prognosis of patients, so as to control the epidemic situation and improve the cure rate. |
| |
| Keywords: | |
|
| 点击此处可从《》浏览原始摘要信息 |
|
点击此处可从《》下载全文 |
|
