新型冠状病毒肺炎核酸检测阳转阴前后CT影像对比

doi:10.19871/j.cnki.xfcrbzz.2020.03.009

摘要/Abstract

摘要： 目的对比分析新型冠状病毒肺炎（COVID-19）患者核酸检测阳转阴前后的CT影像,探讨CT影像在临床诊疗中的价值。方法回顾性分析苏州大学附属传染病医院32例COVID-19核酸检测末次阳性前及首次转阴后的胸部CT影像,对比观察其CT表现;并对病灶范围半定量评分,使用秩和检验分析组间差异。根据《新型冠状病毒肺炎影像学诊断指南（2020第一版）》判断32例核酸首次转阴后CT影像是否进入转归期。结果 32例COVID-19核酸阳转阴前后的CT影像均表现为病毒性肺炎,病灶以双侧、非对称性、胸膜下分布为主。在核酸首次转阴后,24例（75.00%）病灶范围减少,7例（21.87%）增加,1例（3.13%）变化不明显;13例（40.63%）病灶密度减低,12例（37.50%）增高,7例（21.88%）变化不明显。核酸阳转阴前后的网格征、支气管空气征、血管增粗分别为87.50%/84.38%、96.88%/87.50%、46.88%/34.38%。核酸首次转阴后肺内总体病灶范围较末次阳性时减小,核酸阳转阴前后的病灶范围半定量评分差异具有统计学意义（P<0.05）。对核酸首次转阴后CT影像进行诊断,27例（84.38%）进入转归期。结论 COVID-19患者核酸检测阳转阴性前后CT表现存在一定差异,核酸首次转阴后的CT影像多诊断为转归期,能够帮助临床进行诊疗效果的评价。

关键词: 新型冠状病毒肺炎, 核酸, 体层摄影术, X线计算机

Abstract: Objective To compare and analyze the CT images of patients with coronavirus disease 2019（COVID-19）before and after their nucleic acid detection results turning from positive to negative, and to evaluate the value of CT in clinical diagnosis and treatment. Methods In this retrospective analysis, 32 cases of COVID-19 from the Affiliated Infectious Diseases Hospital of Soochow University were enrolled. Chest CT images were acquired before the last positive nucleic acid test and after the first negative test. The imaging findings of the two timepoints were compared and observed, and a semi-quantitative scoring system was used to quantitatively estimate the extent of lesion in each lung lobe, using rank sum test. According to the "Guidelines for Imaging Diagnosis of New Coronavirus Pneumonia (First Edition 2020)", whether the CT images of 32 cases entered the absorption stage after the first negative nucleic acid test were determined. Results The CT images of 32 cases of COVID-19 during the transition from positive to negative in nucleic acid detection results all showed signs of viral pneumonia. The lesions were mainly bilateral, asymmetric, and subpleural distribution. After the nucleic acid test result turned negative for the first time, the lesion was decreased in extent in 24 cases (75.00%), increased in 7 cases (21.87%), and showed no overt change in 1 case (3.13%); The lesion density was decreased in 13 cases (40.63%), increased in 12 cases (37.50%) and showed no overt change in 7 cases (21.88%). The occurrence of intralobular septal thickening, air bronchogram sign, and enlarged vasculature sign before the last positive nucleic acid test and after the first negative test were 87.50% vs 84.38%, 96.88% vs 87.50%, 46.88% vs 34.38%. Compared with the lesion extent before the last positive nucleic acid test, the overall lesion extent after the negative test were significantly decreased in the semi-quantitative scores of lesion extent (P<0.05). Based on CT images diagnosis after the nucleic acid test turned negative for the first time, and 27 cases (84.38%) entered the absorption stage. Conclusion sThere is certain difference in CT image findings during the transition from positive to negative in nucleic acid test in patients with COVID-19, and the CT image findings after the first negative nucleic acid test are mostly indicating the absorption stage, which can assist the clinical evaluation of therapeutic efficacy.

Key words: Coronavirus disease 2019, Nucleic acid, Tomography, X-ray computed

朱芸仙, 刘静, 任砚, 吴敏昱, 任荣, 朱怡, 姚文妍, 李敏. 新型冠状病毒肺炎核酸检测阳转阴前后CT影像对比[J]. 新发传染病电子杂志, 2020, 5(3): 183-187.

Zhu Yunxian, Liu Jing, Ren Yan, Wu Minyu, Ren Rong, Zhu Yi, Yao Wenyan, Li Min. Comparative analysis of CT images acquired before and after coronavirus disease 2019 turning from positive to negative by nucleic acid testing[J]. Electronic Journal of Emerging Infectious Diseases, 2020, 5(3): 183-187.

参考文献

[1] Jiang F, Deng L, Zhang L, et al.Review of the Clinical Characteristics of Coronavirus Disease 2019(COVID-19)[J]. J Gen Intern Med, 2020, 35(5):1545-1549.
[2] 中华人民共和国卫生健康委员会. 新型冠状病毒感染的肺炎诊疗方案(试行第七版)[S/OL]. 国卫办医涵[2020]184号.[2020-03-03].http://www.nhc.gov.cn/yzygj/s7653p/202003/46c9294a7dfe4cef80dc7f5912eb1989.shtml.
[3] Yang Y, Yang M, Shen C, et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of2019-nCoV infections[J/OL]. medRxiv, Posted February 17, 2020, doi: https://doi.org/10.1101/2020.02.11.20021493.
[4] 中华医学会放射学分会传染病放射学组. 新型冠状病毒肺炎影像学诊断指南(2020第一版)[J]. 医学新知,2020,30(1):22-34.
[5] Lai CC, Shih TP, Ko WC, et al.Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 (COVID-19): The epidemic and the challenges[J]. Int J Ant Agents, 2020, 55(3):105924.
[6] Singhal T.A Review of Coronavirus Disease-2019 (COVID-19)[J]. Indian J Pediatr, 2020, 87(4):281-286.
[7] Chung M, Bernheim A, Mei X, et al.CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)[J]. Radiology, 2020, 295(1): 202-207.
[8] 卢亦波, 周静如, 莫移美, 等. 31例新型冠状病毒肺炎临床及CT影像表现初步观察[J]. 新发传染病电子杂志, 2020, 5(2): 79-82.
[9] 郭兰田, 姜兴岳, 谢庆芝, 等. 危重症甲型H1N1流感病毒肺炎的多层螺旋CT表现[J]. 中国临床医学影像杂志, 2011, 22(2): 92-95.
[10] 邓莹莹, 黄华, 袁静, 等.人感染H7N9禽流感病毒性肺炎临床影像学诊断及疗效评价[J]. 新发传染病电子杂志, 2017, 2(1): 46-49.
[11] Tian S, Hu W, Niu L, et al.Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID-19) Pneumonia in Two Patients With Lung Cancer[J]. J Thorac Oncol, 2020, 15(5): 700-704.
[12] 郑秋婷,卢亦波,谭理连,等.新型冠状病毒肺炎临床及影像学研究进展[J].新发传染病电子杂志,2020,5(2):140-144.
[13] 何慕芝,蔡闯,王继业,等. 反晕征的病因谱及临床意义研究进展[J]. 国际呼吸杂志, 2018,38(19):1516-1519.
[14] 宋璐,曾莹婷,龚晓明,等. 新型冠状病毒肺炎影像表现及鉴别诊断[J].新发传染病电子杂志,2020,5(2):82-86.
[15] Pan F, Ye T, Sun P, et al.Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19)[J]. Radiology, 2020, 295(3):715-721.
[16] Ksiazek TG, Erdman D, Goldsmith CS, et al.A novel coronavirus associated with severe acute respiratory syndrome[J]. N Engl J Med, 2003, 348(20):1953-1966.
[17] Jonsdottir HR, Dijkman R.Coronaviruses and the human airway: a universal system for virus-host interaction studies[J]. Virol J, 2016, 13:24.
[18] Zhu N, Zhang D, Wang W, et al.A novel coronavirus from patients with pneumonia in China, 2019[J]. NEngl J Med, 2020, 382(8): 727-733.
[19] 钟慧钰, 赵珍珍, 宋兴勃, 等. 新型冠状病毒核酸临床检测要点及经验[J]. 国际检验医学杂志, 2020, 41(5): 523-526.