Chinese Medical Sciences Journal ›› 2020, Vol. 35 ›› Issue (3): 254-261.doi: 10.24920/003727
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
Chen Xu,Zhang Gang,Hao Shuaiying,Bai Lin(),Lu Jingjing()
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。
Chen Xu, Zhang Gang, Hao Shuaiying, Bai Lin, Lu Jingjing. 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[J].Chinese Medical Sciences Journal, 2020, 35(3): 254-261.
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References | Year | Country | Publication type | Sample size (n) |
---|---|---|---|---|
COVID-19 | ||||
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"
Items | COVID-19 | MERS | SARS | χ2 | P |
---|---|---|---|---|---|
Total number of early phase CT | 147 | 37 | 85 | ||
GGO consolidation pattern | 7.966 | 0.093 | |||
Mixed GGO&Consolidation | 41(27.9) | 10(27.0) | 23(27.1) | ||
GGO mainly | 89(60.5) | 16(43.2) | 49(57.6) | ||
Consolidation mainly | 17(11.6) | 11(29.7) | 13(15.3) | ||
Laterality | 13.053 | 0.316 | |||
Bilaterality | 98(66.7) | 25(67.6) | 39(78.0) | ||
Unilaterality | 49(33.3) | 12(32.4) | 11(22.0) | ||
Not accessible* (n) | 0 | 0 | 35 | ||
More severe in the lower lobes | 4.809 | 0.535 | |||
Yes | 60(74.7) | 27(73.0) | 11(61.1) | ||
No | 21(25.9) | 10(27.0) | 7(38.9) | ||
Not accessible* (n) | 66 | 0 | 67 | ||
Geographic distribution | 23.509 | <0.05 | |||
Focal | 45(40.5) | 6(16.2) | 18(42.8) | ||
Multifocal | 66(59.5) | 20(54.0) | 16(38.1) | ||
Extensive | 0 | 11(29.7) | 8(19.1) | ||
Not accessible* (n) | 36 | 0 | 43 | ||
Transverse distribution | 13.053 | <0.001 | |||
Central | 15(17.8) | 8(21.6) | 3(4.7) | COVID-19 vs. SARS, P<0.001 | |
Peripheral | 55(65.4) | 17(45.9) | 28(44.4) | COVID-19 vs. MERS, P=0.09 | |
No predilection | 14(16.7) | 12(32.4) | 32(50.8) | SARS vs. MERS, P=0.02 | |
Not accessible* (n) | 63 | 0 | 22 | ||
Nodular lesion | 0 | 4(10.8) | 14(15.7) | <0.001 | |
Septal thickening | 17(11.6) | 16(43.2) | 12(13.5) | 22.412 | <0.001 |
Fibrotic changes | 2(1.4) | 2(5.4) | 7(7.9) | 6.275 | <0.05 |
Tree-in-bud | 0 | 5(13.5) | 0 | <0.05 | |
Cavitation | 0 | 4(10.8) | 0 | <0.05 | |
Crazy paving pattern | 10(6.8) | 10(27.0) | 26(29.2) | 23.037 | <0.001 |
Organizing pneumonia pattern | 1(0.7) | 4(10.8) | 7(7.9) | <0.05 | |
Pleural effusion | 0(0) | 21(56.8) | 12(13.5) | <0.001 |
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