COVID-19发病首周胸部HRCT表现对疾病进展的预测价值

目的探讨新型冠状病毒肺炎(COVID-19)病人发病首周胸部高分辨力CT(HRCT)表现对疾病进展的预测价值。方法回顾性分析67例确诊COVID-19病人发病首周胸部HRCT影像及临床资料,男38例,女29例,平均(49.6±17.6)岁,根据病人病程进展情况分为疾病缓解组55例,平均年龄(46.1±16.7)岁]和疾病进展组12例,平均年龄(65.6±12.3)岁]。比较2组的一般临床资料及CT影像特征,分别采用卡方检验、t检验及Fisher确切概率检验比较性别、年龄及CT征象,采用Mann-Whitney U检验分析实验室检查结果及CT病变范围。采用Logistic回归检验分析差异有统计学意义的因素对于疾病进程的预测能力。结果 67例病人中,62例病人呈多肺叶胸膜下区分布并表现为磨玻璃密度影(GGO)(92.54%),多伴有肺实变(74.63%)及含气支气管征(80.6%);少见小叶核心结节、胸腔积液及心包积液。2组病人性别差异无统计学意义(P>0.05)。与缓解组相比,进展组年龄更大、C反应蛋白(CRP)更高、受累肺叶更多、CT评分更高,更多出现胸膜增厚(均P<0.05),其余CT征象差异均无统计学意义(均P>0.05)。对年龄、CRP、受累肺叶、CT评分和胸膜增厚进行Logistic回归分析显示,病人年龄较大(OR=1.082,95%CI:1.018~1.149;P=0.011)及发病首周HRCT受累肺叶较多(OR=2.716,95%CI:1.086~6.790;P=0.033)是提示病人治疗中临床分型升级的独立影响因素。结论 COVID-19发病首周胸部CT表现具有一定特征,年龄大且受累肺叶多者病程中易发展为重症及危重症。

Predicting COVID-19 progression with the first week high-resolution CT

Objective To investigate the value of the first week high-resolution CT(HRCT)in predicting COVID-19 procession.Methods HRCT within 7 days after symptom onset and clinical data of 67 patients(38 males,29 females;mean age 49.6±17.6 years)with COVID-19 were retrospectively reviewed.The patients were divided into two groups:improved group(55 cases,mean age 46.1±16.7 years)and progress group(12 cases,mean age 65.6±12.3 years).The Chisquare test and t test or Fisher exact test were used to compare the sex,age and CT findings between the two groups when appropriate,and the Mann-Whitney U test was used to compare the laboratory examination results and lesion extent on CT.The logistic regression test was performed to identify HRCT characteristics in predicting the disease progression.Result Sixty-two of 67 patients had abnormal HRCT findings.The CT findings included multilobar peripheral ground-glass opacities(92.54%),consolidation(74.63%),and air bronchograms(80.6%).Lobular core nodules,pleural effusions,or pericardial effusion were not common findings.There was no significant difference in sex between the 2 groups(P>0.05).The patients were older and had higher C-reaction protein(CRP)level in progress group than in the improved group(all P<0.05).In the progress group,the frequency of pleural thickening,a higher number of lung lobes involvement and the total lung severity score on CT were much common(P<0.05)compared with the improved group.In the logistic regression,the elder age(OR=1.082,95%CI:1.018-1.149,P=0.011),the higher number of lung lobes involvement in the first week(OR=2.716,95%CI:1.086-6.790,P=0.033)were independent predictors of a worse disease course.Conclusion CT manifestations have certain characteristics in the first week of onset.Older age and more lung lobes involvement on chest HRCT scan in the first week could predict an worse clinical course in COVID-19 pneumonia.