重症人禽流感病毒性肺炎的影像学表现及动态变化

目的探讨重症人禽流感病毒（高致病性H5N1型）肺炎的影像学检查方法及胸部X线与CT影像表现及动态变化。方法回顾性分析2例由卫生部确诊，并经过抢救治疗痊愈的重症人禽流感病毒性肺炎病人的相关临床、影像学和随访资料。结果胸部影像学表现及动态变化：①磨玻璃样片状影及肺实变影是人禽流感病毒性肺炎较早出现的影像学表现；②病灶侵犯肺组织广泛，表现为多叶多段的两肺广泛受累；③病灶蔓延变化迅速；④病灶吸收慢、迁延时间长，恢复期2a随访有肺纤维化的影像表现。结论重症人禽流感病人具有实变出现早、病灶变化快且广泛，病灶吸收相当缓慢等特点。通过影像学的动态观察，在指导临床诊断、鉴别诊断以及及时有效地确定治疗方案，评价疗效等方面均有一定价值。

Imaging manifestations and dynamic change of the severe cases of pneumonia caused by H5N1 Subtype human avian influenza virus

Objective To explore imaging examination methods for the severe cases with pneumonia caused by H5N1 Subtype human cases of avian influenza virus and the imaging manifestation and dynamic change in chest X ray and CT. Methods A retrospective analysis of the relevant clinical and imaging materials and follow up of two severe cases with pneumonia caused by highly pathogenic H5N1 Subtype human avian influenza virus ,whose diagnosis were confirmed by the Ministry of Health being cured after rescuing, was taken. Results The imaging features and dynamic state change of the chest were： ①Presence of ground-glass like shadows and big and small-sized flaky shadows as well as parenchyma changes in lungs were the imaging manifestations early in this disease of the severe cases with pneumonia caused by H5NI Subtype human avian influenza virus; ②Focus of infection was an extensive invasion of the lung tissues shown by an extensive involvement of multiple leafiness and segments of both lungs; ③Focus of infection spread and changed rapidly; ④The disease focuses absorbed slowly and protracted in a long time,there were such changes in imaging manifestations as pulmonary fibrosis in following up two years of convalescence stage. Conclusions The severe cases with pneumonia caused by H5N1 Subtype human cases of avian influenza virus had the clinical imaging features of early parenchyma changes in lungs and rapid spreading and absorption of the disease focuses with prolongation in time. Dynamic observation on imaging changes and imaging features of the severe cases of pneumonia remain to be the important measures for making clinical diagnosis and differential diagnosis, ascertaining therapeutic regimen efficiently in time and evaluating therapeutic effects.