Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (3): 254-261.doi: 10.24920/003727

• 论著 • 上一篇    下一篇

新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒所致肺炎早期肺部CT表现异同:基于系统性回顾对比分析

陈旭,张刚,郝帅营,白林(),陆菁菁()   

  1. 北京和睦家医院放射科,北京市朝阳区将台路2号,100015
  • 收稿日期:2020-02-29 出版日期:2020-09-30 发布日期:2020-09-25
  • 通讯作者: 白林,陆菁菁 E-mail:bai.lin@ufh.com.cn;cjr.lujingjing@vip.163.com

Similarities and Differences of Early Pulmonary CT Features of Pneumonia Caused by SARS-CoV-2, SARS-CoV and MERS-CoV: Comparison Based on a Systemic Review

Chen Xu,Zhang Gang,Hao Shuaiying,Bai Lin(),Lu Jingjing()   

  1. Department of Radiology, Beijing United Family Hospital, Beijing 100015, China
  • Received:2020-02-29 Published:2020-09-30 Online:2020-09-25
  • Contact: Bai Lin,Lu Jingjing E-mail:bai.lin@ufh.com.cn;cjr.lujingjing@vip.163.com

摘要:

目的 利用系统性回顾分析对比由新型冠状病毒、非典型肺炎冠状病毒及中东呼吸综合征冠状病毒导致的3种病毒性肺炎早期肺部CT表现的相似性及差异性。
方法 运用电子数据库分别检索成人新型冠状病毒肺炎、非典型肺炎及中东呼吸综合征冠状病毒肺炎CT表现的研究论文及病例报道。文献质量及数据完整性依3位放射科医生所达成的共识进行评估。采用选票计数法纳入各组病例。3组肺炎患者早期胸部CT表现包括病变形态、分布及特殊影像学征象,数据分别提取并记录。利用SPSS 22.0对数据进行对比分析。
结果 本文共纳入24项研究,其中新型冠状病毒病10项、中东呼吸综合征5项以及严重急性呼吸系统综合症9项。纳入的CT检查分别为147、40及122例。对于3种肺炎的早期CT表现,3组间“混合磨玻璃影及实变”、“以磨玻璃影为主”或“以实变为主”的基本病变形态无明显差异(χ2=7.966, P>0.05)。对于“主要累及双肺下叶及胸膜下区”这一病变分布特征,3组间无显著差异(χ 2=4.809, P>0.05)。新型冠状病毒肺炎早期病灶表现更为局限(χ 2=23.509, P<0.05)。铺路石征(χ 2=23.037, P<0.001)、机化性肺炎(P<0.05)及胸腔积液(P<0.001)在新型冠状病毒肺炎的比例明显低于另外两组。尽管纤维条索在全部3种病毒性肺炎中很少出现,但更多见于严重急性呼吸系统综合症(χ 2=6.275, P<0.05)。对于其他影像学表现,只有中东呼吸综合征肺炎早期CT出现了树芽征、空洞,并且其小叶间隔增厚发生率较另外两种肺炎明显增加(χ 2=22.412, P<0.05)。每组早期CT表现均未见气胸、纵隔气肿及淋巴结肿大。
结论 3种冠状病毒肺炎早期影像表现具有相似的基本病变特征,包括磨玻璃影及实变、双侧分布,特别是以双肺下叶及胸膜下区分布为主。新型冠状病毒肺炎早期炎症程度较轻,早期纤维化改变仅见于严重急性呼吸系统综合症。中东呼吸综合征具有更严重的炎性改变包括空洞及胸腔积液。这些差异可能提示每种冠状病毒肺炎具有其特殊的病理生理学进程。

关键词: 计算机X线断层摄影术, 肺炎, 病毒, 2019冠状病毒病, 严重急性呼吸系统综合症冠状病毒, 中东呼吸综合征冠状病毒, 2型严重急性呼吸系统综合症冠状病毒

Abstract:

Objective To compare the similarities and differences of early CT manifestations of three types of viral pneumonia induced by SARS-CoV-2 (COVID-19), SARS-CoV (SARS) and MERS-CoV (MERS) using a systemic review.
Methods Electronic database were searched to identify all original articles and case reports presenting chest CT features for adult patients with COVID-19, SARS and MERS pneumonia respectively. Quality of literature and completeness of presented data were evaluated by consensus reached by three radiologists. Vote-counting method was employed to include cases of each group. Data of patients’ manifestations in early chest CT including lesion patterns, distribution of lesions and specific imaging signs for the three groups were extracted and recorded. Data were compared and analyzed using SPSS 22.0.
Results A total of 24 studies were included, composing of 10 studies of COVID-19, 5 studies of MERS and 9 studies of SARS. The included CT exams were 147, 40, and 122 respectively. For the early CT features of the 3 pneumonias, the basic lesion pattern with respect to “mixed ground glass opacity (GGO) and consolidation, GGO mainly, or consolidation mainly” was similar among the 3 groups (χ2=7.966, P>0.05). There were no significant differences on the lesion distribution (χ2=13.053, P>0.05) and predominate involvement of the subpleural area of bilateral lower lobes (χ 2=4.809, P>0.05) among the 3 groups. The lesions appeared more focal in COVID-19 pneumonia at early phase (χ 2=23.509, P<0.05). The proportions of crazy-paving pattern (χ 2=23.037, P<0.001), organizing pneumonia pattern (P<0.05) and pleural effusions (P<0.001) in COVID-19 pneumonia were significantly lower than the other two. Although rarely shown in the early CT findings of all three viral pneumonias, the fibrotic changes were more frequent in SARS than COVID-19 and MERS (χ 2=6.275, P<0.05). For other imaging signs, only the MERS pneumonia demonstrated tree-in-buds, cavitation, and its incidence rate of interlobular or intralobular septal thickening presented significantly increased as compared to the other two pneumonia (χ 2=22.412, P<0.05). No pneumothorax, pneumomediastinum and lymphadenopathy was present for each group.
Conclusions Imaging findings on early stage of these three coronavirus pneumonias showed similar basic lesion patterns, including GGO and consolidation, bilateral distribution, and predominant involvement of the subpleural area and the lower lobes. Early signs of COVID-19 pneumonia showed less severity of inflammation. Early fibrotic changes appeared in SARS only. MERS had more severe inflammatory changes including cavitation and pleural effusion. The differences may indicate the specific pathophysiological processes for each coronavirus pneumonia.

Key words: computer tomography, pneumonia, viral, COVID-19, severe acute respiratory syndrome coronavirus, Middle East respiratory syndrome coronavirus, severe acute respiratory syndrome coronavirus 2

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