胸部CT首诊征象对疑似输入性新型冠状病毒肺炎的价值

马培旗; 袁玉山; 陈飞; 张楠楠; 董振

doi:10.13898/j.cnki.issn.1000-2200.2020.02.005

胸部CT首诊征象对疑似输入性新型冠状病毒肺炎的价值

Value of the first chest CT manifestations for suspected imported COVID-19

摘要

摘要:
目的探讨胸部CT首诊征象对疑似输入性新型冠状病毒肺炎（COVID-19）的临床价值。
方法回顾性分析34例疑似输入性COVID-19首诊CT表现及临床资料。通过两独立样本t检验比较CT不同分期病人发病时间的差异性；通过Fisher确切概率法比较胸部CT方法与经一次核酸检测方法对确诊输入性COVID-19的差异性。
结果34例疑似病例中COVID-1931例，其他类肺炎3例（其中甲型流感肺炎1例，乙型流感肺炎1例，甲型流感合并乙型流感1例）。31例COVID-19胸部CT阳性者30例，阴性1例。胸部CT表现为早期的21例，进展期9例，重症期0例。进展期组病人发病时间（6.50±1.90）d，大于早期组（2.32±1.13）d（P < 0.01）。3例其他类型肺炎均表现为双肺散在多发磨玻璃影，部分可见实变。经一次核酸检测确诊23例，行2次或2次以上核酸检测确诊病例8例。胸部CT特征性表现较经一次核酸检测方法对确诊输入性COVID-19的阳性率高（P < 0.05）。
结论输入性COVID-19肺炎胸部CT虽然表现多样，但仍具有一定特征，多为双肺胸膜下多发磨玻璃影、部分实变，进展期病灶相互融合。对疑似病例而言，胸部CT的特征性表现较经一次核酸检测方法阳性率较高，特殊时期对于疑似病例具有特征性CT表现者应同确诊病例一样对待。

Abstract:
ObjectiveTo evaluate the clinical value of the first chest CT manifestations for suspected imported corona virus disease 2019 (COVID-19).
MethodsThe first CT manifestations and clinical data of 34 patients with suspected imported COVID-19 were analyzed retrospectively.The difference of the onset time of patients at different stages confirmed by CT was compared by the two independent samples t-test, and the difference between the chest CT and one-time nucleic acid test for the diagnosis of imported COVID-19 was compared by Fisher's accurate probability method.
ResultsIn the 34 suspected cases, 31 cases were found with COVID-19, and 3 cases with other types of pneumonia (including 1 case of influenza A virus pneumonia, 1 case of influenza B virus pneumonia and 1 case of influenza A and B mixed? virus pneumonia).In the 31 COVID-19 cases, 30 cases were positive and 1 case was negative by chest CT.Chest CT showed 21 cases were at early stage, 9 cases at progressive stage, 0 case at severe stage.The onset time of patients in progressive stage group(6.50±1.90)d was longer than that in early stage group (2.32±1.13)d (P < 0.01).Three cases with other pneumonia showed bilateral pulmonary scattered ground-glass shadows, some of which showed consolidation.Twenty-three cases were confirmed by one-time SARS-CoV-2 nucleic acid test, and 8 cases were confirmed by two or more times of nucleic acid test.The positive rate of characteristic chest CT manifestations was higher than that of one-time nucleic acid test in the diagnosis of imported COVID-19 (P < 0.05).
ConclusionsAlthough the chest CT manifestations of imported COVID-19 are various, there still are certain characteristics, most of these are multiple ground-glass shadows and partial consolidation under the pleura of both lungs, and the lesions at progressive stage fuse with each other.For suspected cases, the positive rate of characteristic chest CT manifestations is higher than that of one-time nucleic acid test, and those with characteristic CT manifestations in special period should be treated as confirmed cases.

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