瑞金医院呼吸与放射科团队发现新冠疫情早期CT无阳性表现不能排除新冠病毒感染可能性

新冠疫情之初，大量病例于武汉集中爆发，所发表的研究都集中于湖北地区，且影像学研究较少。学界对湖北以外区域新冠肺炎患者的临床症状和影像学表现知之甚少，新冠肺炎患者的临床症状、影像学表现是否存在地域差异，相关研究具有一定的迫切性。在温州地区，由于温州居民的从商特性，农历新年期间约有33000人自湖北返回温州，造成了疫情初期，温州成为了湖北省之外全中国新冠发病率最高的城市。截止2020年2月15日，温州共有499例新冠肺炎病例。针对上述情况，我院牵头，联合温州的三家市级定点收治新冠肺炎患者的医院共同参与，开展了此项包括149例患者的回顾性研究。研究发现，温州地区患者中，发热、咳嗽、咳痰是最常见的症状，大多数患者为轻症患者。在发病第一周，胸部CT检查中，出现分布在肺下叶、外周带为主的多灶性磨玻璃或混合磨玻璃影时，高度提示COVID-19肺炎。此外，研究发现一些患者虽COVID-19核酸检测阳性，但其胸部CT无阳性表现，因此提示即使胸部CT阴性，亦不能排除COVID-19感染的可能性。

【Abstract】

Background:Little is known about COVID-19 outside Hubei. The aim of this paper was to describe the clinical characteristics and imaging manifestations of hospitalized patients with confirmed COVID-19 infection in Wenzhou, Zhejiang, China.

Methods: In this retrospective cohort study, 149 RT-PCR confirmed positive patients were consecutively enrolled from January 17th to February 10th, 2020 in three tertiary hospitals of Wenzhou. Outcomes were followed up until Feb 15th, 2020.

Findings:A total of 85 patients had Hubei travel/residence history, while another 49 had contact with people from Hubei and 15 had no traceable exposure history to Hubei. Fever, cough and expectoration were the most common symptoms, 14 patients had decreased oxygen saturation, 33 had leukopenia, 53 had lymphopenia, and 82 had elevated C-reactive protein. On chest computed tomography (CT), lung segments 6 and 10 were mostly involved. A total of 287 segments presented ground glass opacity, 637 presented mixed opacity and 170 presented consolidation. Lesions were more localized in the peripheral lung with a patchy form. No significant difference was found between patients with or without Hubei exposure history. Seventeen patients had normal CT on admission of these, 12 had negative findings even10 days later.

Interpretation:Most patients presented with a mild infection in our study. The imaging pattern of multifocal peripheral ground glass or mixed opacity with predominance in the lower lung is highly suspicious of COVID-19 in the first week of disease onset. Nevetheless, some patients can present with a normal chest finding despite testing positive for COVID-19.

【中文摘要】

背景：新冠肺炎疫情爆发初期，学界对湖北以外的COVID-19病例知之甚少。本研究的目的是描述浙江省温州市确诊为COVID-19感染的住院患者的临床特征和影像学表现。

方法：本研究为回顾性队列研究，纳入温州市三所三级医院自2020年1月17日至2月10日收治的、共149例RT-PCR阳性患者。研究结果随访到2020年2月15日。

结果：队列中共有85例患者有湖北旅行或居住史，49例患者有湖北居民接触史，15例患者无湖北相关接触史。发热、咳嗽、咳痰是最常见的症状，14例患者血氧饱和度降低，33例患者白细胞减少，53例患者淋巴细胞减少，82例患者C反应蛋白升高。在胸部CT图像中，肺6、10段最常受累。共287个肺段发现磨玻璃影，637个肺段发现混合磨玻璃影，170个肺段发现实变影。病变多呈斑片状，分布于肺外周带。有湖北接触史的患者与无湖北接触史的患者相比无显著差异。17例患者入院时CT检查为阴性，其中12例患者10天后CT表现仍为阴性。

结论：在我们的研究中，大多数患者为轻症。在发病第一周，出现分布在肺下叶、外周带为主的多灶性磨玻璃或混合磨玻璃影时，应高度怀疑COVID-19肺炎。此外，一些患者虽COVID-19核酸检测阳性，但其胸部CT无阳性发现。