新型冠状病毒肺炎CT征象再讨论

目的寻找新型冠状病毒肺炎（NCP）的特征性CT征象，并从影像病理学角度探讨其临床意义。方法收集整理2020年1月26日至2月12日河北省确诊为NCP的40例病人的CT图像，对其72侧肺部，234个肺段，共459个病灶进行分析；同时与随机抽取的20例本院诊治的其他性质肺炎（非NCP）病人的28侧肺部，79个肺段，共258个病灶的CT图像进行比较研究。结果NCP组病灶多位于两肺下叶（分别为30个，23.44%），多累及双侧（32例，80.00%），且累及5个肺叶的比例较大，其在左、右侧肺分布上差异不大，伴有胸腔积液的仅为1例（2.50%）。NCP组与非NCP组在病灶累及肺叶数量、扇形分布、肺血增多或肺水肿、伴有血管增粗和支气管壁增厚上差异有统计学意义。18例有复查资料的患者中有进展的为13例（占72.22%），其中8例有肺血增多或肺水肿（占62%），11例累及双侧（约占85%）。结论NCP的CT表现有其特征性，而且其可能更容易侵犯血管引起血管炎，进而会导致肺水肿和心肺循环紊乱的发生，这对于预测患者病情发展可能具有提示作用。

Re-discussion about CT signs of novel coronavirus pneumonia

Objective To search for the characteristic CT signs of the new coronavirus pneumonia(NCP)and to explore its clinical significance from the perspective of imaging pathology.Methods CT images of 40 NCP patients in Hebei Province were collected and a total of 459 lesions in 234 lung segments on 72 sides were analyzed.Meanwhile,CT images of totally 258 lesions in 79 lung segments on 28 sides of 20 non-NCP patients randomly selected and treated in our hospital were compared with those of NCP patients above.Results In NCP group,the lesions were mostly located in the lower lobe of two lungs(30 cases,accounting for 23.44%respectively),with bilateral involvement(32 cases,accounting for 80.00%).The proportion of lesions involving 5 pulmonary lobes was relatively large,with little difference in the distribution of left and right lung,and only 1 case(2.50%)with pleural effusion.There were significant differences between NCP group and non-NCP group in fan-shaped shape,peripheral distribution,pulmonary hyperemia or pulmonary edema,accompanied by vascular thickening and bronchial wall thickening.These suggested that the lesions of NCP were initially in the periphery and gradually infiltrate and fuses on the basis of fan-shaped structures.And the lesions were mostly accompanied by vascular thickening and pulmonary hyperemia,but with little bronchial wall thickening.Conclusion The CT signs of NCP are characteristic,and they may be more likely to invade blood vessels and cause vasculitis,which may lead to pulmonary edema and cardio-pulmonary circulation disorder.