新型冠状病毒肺炎CT半定量评估与临床分型相关性研究

Correlation between CT semi-quantitative evaluation and clinical staging of coronavirus disease 2019

摘要:

目的：探究新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）胸部CT半定量评分及分级与临床分型的相关性。方法：回顾性分析2020年1至2月重庆医科大学附属永川医院收治的71例COVID-19患者的临床和影像资料，将患者依据《新型冠状病毒肺炎诊疗方案（试行第六版）》分为轻型（8例）、普通型（53例）、重型（8例）、危重型（2例），比较不同临床分型患者的实验室检查结果，并分析其胸部CT影像表现，根据病变的部位、范围、密度进行半定量评分，计算肺部炎症指数并将其分为5级，分析肺部炎症指数分级与临床分型的相关性。结果：COVID-19的主要临床症状为发热（49例）、咳嗽（43例）等。不同临床分型间淋巴细胞计数、C反应蛋白、红细胞沉降率及降钙素原差异具有统计学意义（P<0.05）。CT表现中，PII 0级中轻型患者8例（100%）；PIIⅠ级中普通型患者34例（97.1%），重型患者1例（2.9%）；PII Ⅱ级中普通型患者17例（94.4%），重型患者1例（5.6%）；PII Ⅲ级中普通型患者2例（28.6%），重型患者5例（71.4%）；PII Ⅳ级中重型患者1例（33.3%），危重型患者2例（66.7%），其差异具有统计学意义（P<0.05）。CT肺部炎症指数分级与临床分型呈正相关，相关系数r=0.75。结论：COVID-19患者的胸部CT半定量评分及分级与临床分型间具有较好的相关性，对临床诊治具有指导意义。

Abstract:

Objective：To explore the correlation between the classification of chest CT semi-quantitative score and clinical classification of coronavirus disease 2019（COVID-19）. Methods：Clinical and imaging data of 71 patients with COVID-19 admitted to our hospital from January 2020 to February 2020 were retrospectively analyzed. According to the diagnosis and treatment program of new coronavirus pneumonia（trail version 6），the patients were divided into the mild group（n=8），the common group（n=53），the severe group（n=8 cases） and the critical group（n=2）. Differences in laboratory results of patients with different clinical classification were compared，and patients’ CT image manifestations were compared. Semi-quantitative scoring was performed according to the location，extent，and density，and the pulmonary inflammation index（PII） was calculated and divided into five grades，and correlation between the pulmonary inflammation index classification and clinical classification was analyzed. Results：The main clinical symptoms of COVID-19 were fever（n=49） and cough（n=43 cases），etc.. Analysis of laboratory examination results showed that different clinical types were associated with lymphocyte count，C-reactive protein，erythrocyte sedimentation rate and procalcitonin，with statistically significant differences（P<0.05）. In CT findings，there were 8 mild cases（100%） in PII grade 0 group，34 common cases（97.1%） and 1 severe case（2.9%） in the PII grade Ⅰ group，17 common cases（94.4%） and 1 severe case（5.6%） in the PII grade Ⅱ group，2 common cases（28.6%） and 5 severe cases（71.4%） in the PII grade Ⅲ group，and 1 severe case（33.3%） and 2 critical cases（66.7%） in the PII grade Ⅳ group，with statistically significant difference（P<0.05）. CT pulmonary inflammatory index grade was positively correlated with clinical classification，and the correlation coeffi－cient was r=0.75. Conclusion：Chest CT semi-quantitative score and classification of patients with COVID-19 have good corre－lation with clinical classification，which has guiding significance for clinical diagnosis and treatment.