Clinical features, CT manifestations and dynamic changes of COVID-19
YE Xiaoxue1, XIE Yibing1, XU Chongyong2, XU Hui2, YAN Zhihan2, FANG Bidong2, YANG Chaoying2, CHEN Meikui2, CHEN Qi2
1.Department of Radiology, Yongjia County People’s Hospital, Wenzhou 325100, China; 2.Department of Radiology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325027, China
YE Xiaoxue,XIE Yibing,XU Chongyong, et al. Clinical features, CT manifestations and dynamic changes of COVID-19[J]. JOURNAL OF WEZHOU MEDICAL UNIVERSITY, 2020, 50(3): 182-186.
摘要目的：探讨新型冠状病毒肺炎（COVID-19）患者的临床特征、CT表现与动态变化。方法：收集2020年1月20日至2月10日永嘉县人民医院收治的COVID-19患者39例，回顾性分析其临床及实验室特点、CT表现与动态变化。结果：39例COVID-19患者中，轻型3例，普通型28例，重型8例，其中37例患者有明确流行病学史，入院首诊外周血白细胞计数降低5例，淋巴细胞计数降低7例，18例C反应蛋白升高，35例血清淀粉样蛋白A升高。患者出院前临床症状减轻，实验室指标基本恢复正常。肺部病变呈自然进程，入院初诊CT表现为胸膜下小斑片状、结节状磨玻璃密度影，伴或不伴小叶间隔增厚；入院3～6 d CT多表现为病灶增多、范围扩大，实变明显，可见空气支气管征，新发病变呈较淡薄磨玻璃密度影，以两肺中下叶胸膜下分布为主；入院9～11 d CT多数表现为病变范围缩小、密度减低，4例完全吸收，3例残留少许纤维灶病变。结论：COVID-19的临床表现及CT动态变化具有一定特征性，深入了解并认识COVID-19的CT表现可以弥补病毒核酸检验的假阴性现象，以便患者早期隔离、早期干预。
Abstract：Objective: To explore the clinical characteristics, CT manifestations and dynamic changes of patients with corona virus disease 2019 (COVID-19). Methods: A total of 39 patients with COVID-19 from Yongjia County People’s Hospital during January 20 2020 to February 10 2020 were collected, and their clinical and laboratory characteristics, CT manifestations and dynamic changes were retrospectively analyzed. Results: Of 39 COVID-19 patients, 3 were mild, 28 normal and 8 severe; 37 of them had a clear epidemiological history. In the first admission, peripheral blood leukocyte counts decreased in 5 cases, lymphocyte counts decreased in 7 cases, and C-reactive protein levels increased in 18 cases, serum amyloid A levels increased in 35 patients. By the time of discharge, their clinical symptoms were obviously relieved, and laboratory indicators of peripheral blood returned to normal. Pulmonary lesions showed a natural course. On admission, the initial CT manifestations included subpleural patchy, nodular ground glass density shadows, with or without thickening of the lobular septum. 3 to 6 days after admission, the lesions increased, the scope expanded, and the consolidation became obvious, and air bronchus signs were seen. The new lesions showed a thin ground-glass density shadow, and the sub-pleural distribution of the middle and lower lobe of both lungs was dominant. 9 to 11 days after admission, CT showed that the lesion area and density were reduced in mose cases, completely absorbed in 4 cases, and fibrous lesions remained in 3 cases. Conclusion: Certain CT dynamic changes, clinical and laboratory manifestations are characteristic of COVID-19. A deeper understanding of them will make up for the false negative of virus nucleic acid test, so that patients can be early isolated and intervened.
