新型冠状病毒肺炎患者胸部MSCT影像表现与预后的关联性分析

目的：探讨不同预后的新型冠状病毒肺炎（COVID-19）患者多层螺旋计算机体层摄影术（MSCT）的影像表现，分析COVID-19患者预后的影响因素。方法：回顾性分析2020年1月22日—3月8日蚌埠医学院第一附属医院收治的79例COVID-19确诊患者的临床资料和胸部MSCT容积扫描资料，根据患者出院或死亡时MSCT影像有无广泛纤维化表现，分为预后不良组和预后较好组，比较不同预后患者入院时MSCT表现、一般资料和临床及实验室指标的差异。结果：79例患者中，治愈74例，死亡5例，病死率6.3%。患者出院或死亡时MSCT影像表现分为消散或磨玻璃影（27例，34.2%）、混合影（41例，51.9%）和广泛纤维化（11例，13.9%）。单因素分析，与预后较好组比较，预后不良组患者累及肺段数明显增加（P<0.05），体温明显升高（P<0.05），病灶弥漫分布患者比例、重型患者所占比例和白细胞升高患者所占比例明显升高（P<0.05）。其中累及肺段数的临界值为9.5个时，其评估患者预后不良的灵敏度和特异度分别为72.7%和80.9%；体温的临界值为39.1℃时，其评估患者预后不良的灵敏度和特异度分别为54.5%和92.6%。Logistic回归分析，累及肺段数和体温是COVID-19患者预后不良的独立危险因素。结论：COVID-19患者入院时MSCT影像中的病灶累及肺段数和体温与患者预后有密切关联，累及肺段数达9个、体温39.1℃以上提示COVID-19患者容易出现肺广泛纤维化，预后不良。

Analysis on correlation between image features of chest MSCT and prognosis in patients with novel coronavirus pneumonia

Objective: To investigate the imaging features of multi-slice spiral computed tomography (MSCT) in the novel coronavirus pneumonia (COVID-19) patients with different prognosis, and to clarify the influencing factors of the prognosis of COVID-19. Methods: The clinical data and the chest MSCT volume scan data of 79 COVID-19 patients, who were admitted in the First Affiliated Hospital of Bengbu Medical College from January 22 to March 8, 2020, were retrospectively analyzed. According to whether there was extensive fibrosis on the MSCT images at discharge or death, the patients were divided into poor prognosis group and well prognosis group. The differences in the MSCT features, the general data and the clinical and laboratory indexes of the patients with different prognosis were compared. Results: There were 74 cases cured in 79 patients, and 5 cases died and the morbidity was 6.3%. The MSCT features at discharge or death were dissipation or ground glass shadow (27 cases, 34.2%), mixed shadow (41 cases, 51.9%) and extensive fibrosis (11 cases, 13.9%).The results of single factor analysis showed that compared with well prognosis group, the number of involved segments of the lung of the patients in poor prognosis group was increased (P<0.05), the temperature was increased(P<0.05), and the percentages of patients with diffuse lesions,the severe patients and the patients with increased white blood cells were increased(P<0.05). The sensitivity and specificity of the number of involved segments for predicting poor prognosis were 72.7% and 80.9%, respectively, while the cut-off value was 9.5. The sensitivity and specificity of temperature for predicting poor prognosis were 54.5% and 92.6%, respectively, while the cut-off value was 39.1℃.The results of Logistic regression analysis showed that the number of involved segments and temperature were the independent risk factors for the poor prognosis of the COVID-19 patients. Conclusion: The number of involved segments in the MSCT images at admission and the temperature are closely related to the prognosis of COVID-19 patients. The number of involved segments more than 9 and the temperature higher than 39.1℃ indicate that the patients are prone to extensive pulmonary fibrosis and poor prognosis.