早期新型冠状病毒肺炎与普通型肺炎的临床及影像学鉴别诊断

Early COVID-19 and common pneumonia：clinical and imaging differential diagnosis

摘要:

目的：总结早期新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）与普通型肺炎的临床和影像学特征及差异，提高对两者的诊断和鉴别诊断水平。方法：回顾性收集2020年1月25日至2月16日于重庆地区确诊的37例早期COVID-19患者及重庆医科大学附属第一医院诊断的40例早期普通型肺炎（非COVID-19）患者的临床、实验室检查和影像学资料，分析和总结两者之间各指标的差异性。结果：COVID-19与普通型肺炎患者的临床表现相似，但前者多有明确的流行病学史，且白细胞计数、中性粒细胞绝对数和C反应蛋白升高者较少见（P<0.001），而淋巴细胞绝对数降低者多见（P<0.05）。肺部CT图像上，早期COVID-19与普通型肺炎患者的病灶均以磨玻璃密度影（ground glass opacity，GGO）为主（89.2% vs. 90.0%，P=1.000）。COVID-19患者的病灶主要呈圆形或半圆形（19例，51.4%），其次为小斑片状（15例，40.5%），以累及胸膜下区为主（25例，67.6%）。普通型肺炎患病灶主要呈片状GGO伴实变（21例，52.5%），其中以GGO为主（17例，81.0 %），其次为单发或多发小斑片状GGO不伴实变（11例，27.5%），以累及整个肺段或亚段为主（31例，77.5%）。27例COVID-19患者和35例普通型肺炎患者不均质GGO内分别以网格影（16例，59.3%）和多发结节影（27例，77.1%）常见。与COVID-19相比，普通型肺炎病灶内支气管壁增厚更常见（42.5% vs. 8.1%，P=0.001），且病变边界多较模糊（75.0% vs. 45.9%，P=0.002）。结论：COVID-19与普通型肺炎患者肺部早期病灶均以GGO为主，但前者多呈圆形或小斑片状，胸膜下受累为主，其内网格影多见，边界多清晰，后者多呈片状或小斑片状，累及整个肺段或亚段为主，其内实变、结节影及支气管壁增厚多见，边界多模糊。影像结合患者临床信息及实验室检查有助于两者鉴别诊断。

Abstract:

Objective：To summarize the clinical and imaging characteristics and differences between coronavirus disease 2019 （COVID-19） and common pneumonia，and to improve differential diagnosis ability. Methods：Retrospectively collected the clinical and imaging data of 37 cases of early-stage COVID-19 and 40 patients with early-stage common pneumonia（not COVID-19） from January 25，2020 to February 16，2020. The clinical manifes－tations，main laboratory and CT findings of the patients were summarized and compared. Results：The clinical manifestations of COVID-19 were similar to those of patients with common pneumonia，but the former usually had a clear epidemiological history and were less likely to have an increase in white blood cell count，absolute neutrophil counts，and C-reactive protein（P<0.001），while those with decreased absolute lymphocyte counts were more common（P<0.05）. The lesions of early-staged COVID-19 and common pneumonia patients were mainly ground glass opacity（GGO）（89.2% vs. 90.0%，P=1.000）. In patients with COVID-19，the lesions were mainly round or semicircular（19，51.4%），followed by small patchy（15，40.5%），and the subpleural area was mainly involved（25，67.6%）. In patients with common pneumonia，the lesions were mainly patchy GGO with consolidation（21，52.5%） and GGO was the main component（17，81.0%），followed by single or multiple small patchy GGO（11，27.5%），and they mainly involved the entire lung segments or subsegments（31，77.5%）. Reticular shadow（16，59.3%） and multiple nodules（27，77.1%） were frequently seen in heterogeneous GGO in 27 COVID-19 patients and 35 patients with common pneumonia，respectively. Compared with COVID-19，internal bronchial wall thickening（42.5% vs. 8.1%，P=0.001） and blurred boundary（75% vs. 45.9%，P=0.009） were more common in lesions of common pneumonia. Conclusion：The pulmonary lesions of early COVID-19 and common pneumonia were mainly GGO，while the former is mostly round or patchy，mainly involves subpleural region，and frequently has internal reticular shadow and clear boundary，the latter is mostly patchy，mainly involves the entire lung segment or subsegment，and usually had internal consolidations，nodules and thickened bronchial wall，and blurred boundary. Imaging combined with patient’s clinical information and laboratory examinations can help distinguish these two diseases.