新型冠状病毒肺炎不同临床分型间CT和临床表现的相关性研究

目的 探讨新型冠状病毒肺炎(COVID-19)不同临床分型的CT和临床表现的相关性。方法 回顾性分析2020年1月华中科技大学同济医学院附属同济医院确诊的103例COVID-19患者的胸部CT平扫图像和临床资料,根据COVID-19诊疗方案(试行第五版),将所有患者分为普通型(58例)、重型(36例)和危重型(9例),并分析其临床表现、实验室检查和CT表现。CT特征参数包括病灶分布、位置、大小、形态、边缘、数目、密度、肺炎病灶占整肺百分比和肺外表现。不同临床分型的CT特征之间的比较采用χ2或Fisher确切概率法。年龄、从发病到CT检查时间及肺炎病灶占整肺体积百分比之间的比较采用方差分析(正态分布)或Kruskal-Wallis秩和检验(非正态分布)。结果 临床表现方面,危重型COVID-19患者更常见于老年男性,中位年龄65岁。58例普通型COVID-19患者有49例(84%)以发热为首发症状,重型及危重型COVID-19患者均以发热为首发症状,重型(25/36, 69%)及危重型(6/9, 67%)COVID-19患者的咳嗽发生率高于普通型(20/58, 34%)。所有危重型患者存在呼吸困难。CT表现中,普通型COVID-19表现为双肺(41/58, 71%)、多发(40/58, 69%)、磨玻璃(31/58, 52%)或混合型(25/58, 43%)、斑片(56/58, 97%)灶;重型及危重型COVID-19均表现为双肺病灶,重型COVID-19以多发(34/36, 96%)、斑片(33/36, 92%)、混合密度灶(26/36, 72%)为主;9例危重型COVID-19病灶均为大于3 cm的多发混合密度病灶。肺炎病灶占整肺体积的百分比:普通型(12.5%±6.1%)明显低于重型(25.9%±10.7%)及危重型(47.2%±19.2%) COVID-19,两者差异具有统计学意义(P值分别为<0.001、0.002),重型COVID-19也显著低于危重型,差异具有统计学意义(P=0.032)。结论 COVID-19不同临床分型的CT和临床表现存在差异,胸部CT表现具有特征性,不仅能早期诊断,还能对其临床病程及严重程度进行评估。

A correlation study of CT and clinical features of different clinical types of COVID-19

Objective To investigate the CT and clinical features of COVID-19.Methods Chest CT and clinical data of 103 patients who were confirmed as COVID-19 in January 2020 were collected retrospectively.According to diagnosis and treatment of COVID-19(trial version 5),all the patients were classified into common(n=58),severe(n=36)and critical(n=9)types,and their clinical findings,laboratory examination and CT finding were analyzed.CT features included distribution,location,size,shape,edge,number and density of the lesion,percentage of pneumonia lesions of the whole lung and extra-pulmonary manifestations.The CT features among different clinical types were compared usingχ2 test or Fisher's exact probability.Comparisons of age,duration from onset to CT examination,and percentage of pneumonic lesions to total lung volume among different types were performed by using analysis of variance(normal distribution)or Kruskal-Wallis rank sum test(non-normal distribution).Results In terms of clinical manifestations,the patients with critical COVID-19 were more common in elderly men,with a median age of 65 years.Fever was the first symptom in 49(84%)of 58 common patients,and also the first symptom in both severe and critical COVID-19 patients.The incidence of coughing in severe(25/36,69%)and critical(6/9,67%)COVID-19 patients was higher than that in common patients(20/58,34%).All critical patients had dyspnea.CT showed the common COVID-19 was located in bilateral lung(40/58,71%)with multiple(40/58,69%),ground glass(31/58,52%)or mixed(25/58,43%)opacities(56/58,97%),while all the severe and critical COVID-19 were located in bilateral lung(100%)with multiple(34/36,96%),patchy(33/36,92%),or mixed opacities(26/36,72%)in severe patients,and with mixed opacities more than 3 cm in critical patients.As for the percentage of pneumonia focus in the whole lung volume,the common type(12.5%±6.1%)was significantly lower than the severe type(25.9%±10.7%)and the critical type(47.2%±19.2%),with statistically significant differences(P<0.001 and 0.002 respectively),and the severe type COVID-19 was also significantly lower than the critical type(P=0.032).Conclusions CT and clinical features of different clinical types of COVID-19 pneumonia are different.Chest CT findings are characteristic,which can not only help the early diagnosis but also evaluate the clinical course and severity.