Chinese Medical Sciences Journal ›› 2021, Vol. 36 ›› Issue (2): 85-96.doi: 10.24920/003821

• 论著 • 上一篇    下一篇

北京市单中心19例COVID-19患者的流行病学特征、影像学表现及临床转归

宋兰1,朱振宸1,2,赵瑞杰1,李鹏昌3,田杜雪1,杜铁宽4,徐燕5,杨启文3,曹玮6,宋伟1,*(),金征宇1,*()   

  1. 1中国医学科学院 北京协和医学院 北京协和医院 放射科,北京 100730
    2中国医学科学院 北京协和医学院 临床医学专业,北京 100730
    3中国医学科学院 北京协和医学院 北京协和医院 检验科,北京 100730
    4中国医学科学院 北京协和医学院 北京协和医院 急诊科,北京 100730
    5中国医学科学院 北京协和医学院 北京协和医院 呼吸与危重症医学科,北京 100730
    6中国医学科学院 北京协和医学院 北京协和医院 感染内科,北京 100730
  • 收稿日期:2021-01-11 出版日期:2021-06-30 发布日期:2021-07-07
  • 通讯作者: 宋伟,金征宇 E-mail:cjr.songwei@vip.163.com;jinzy@pumch.cn

Epidemiologic Features, Radiological Findings andClinical Outcomes of 19 Patients with COVID-19in a Single Center in Beijing, China

Lan Song1,Zhenchen Zhu1,2,Ruijie Zhao1,Pengchang Li3,Duxue Tian1,Tiekuan Du4,Yan Xu5,Qiwen Yang3,Wei Cao6,Wei Song1,*(),Zhengyu Jin1,*()   

  1. 1Department of Radiology,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    2MD Program, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    3Department of Laboratory Medicine,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    4Department of Emergency,Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    5Department of Respiratory and Critical Care Medicine, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
    6Department of Infectious Disease, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
  • Received:2021-01-11 Published:2021-06-30 Online:2021-07-07
  • Contact: Wei Song,Zhengyu Jin E-mail:cjr.songwei@vip.163.com;jinzy@pumch.cn

摘要:

目的描述北京协和医院新型冠状病毒肺炎(COVID-19)确诊患者的流行病学史、临床特征、实验室检查和影像学特征及预后。
方法回顾性分析我院自2020年1月20日至3月5日收诊的19例经核酸检测确诊的SARS-CoV-2感染的患者,最终随访时间为2020年3月14日。通过与患者或家属直接沟通获得流行病学和临床预后资料,从电子病历中检索实验室检查结果,胸部CT图像由两位高年资胸部影像医师进行定性分析,并通过人工智能软件进行定量分析。
结果我们从研究队列中确定了5个家族簇(13/19,68.4%)。所有患者预后良好,临床分型为轻度(3/19)或中度(16/19)。常见症状为发热(15/19,78.9%)和干咳(11/19,57.9%)。两位患者连续3次以上病毒核酸检测结果均为阴性。从发现CT异常到确诊COVID-19的最长时间间隔为30天。出院后随访,1例患者核酸检测复查呈阳性。影像异常表现对于COVID-19的诊断是非特异性的。
结论北京地区COVID-19患者的临床症状多轻微或者无症状。CT影像表现多为非特异性,应避免对COVID-19患者进行大规模CT筛查。调查分析患者的流行病学接触史,并结合临床、影像及实验室检查结果,对COVID-19的早期诊断至关重要。出院后亦建议密切随访监测。

关键词: 冠状病毒, 严重急性呼吸窘迫综合征冠状病毒2型, 新型冠状病毒肺炎, 体层摄影术, X线计算机, 随诊

Abstract:

Objective To describe the epidemiologic, clinical, laboratory, and radiological characteristics and prognoses of COVID-19 confirmed patients in a single center in Beijing, China.
Methods The study retrospectively included 19 patients with nucleic acid-confirmed SARS-CoV-2 infection at our hospital from January 20 to March 5, 2020. The final follow-up date was March 14, 2020. The epidemiologic and clinical information was obtained through direct communication with the patients or their family members. Laboratory results retrieved from medical records and radiological images were analyzed both qualitatively by two senior chest radiologists as well as quantitatively via an artificial intelligence software.
Results We identified 5 family clusters (13/19, 68.4%) from the study cohort. All cases had good clinical prognoses and were either mild (3/19) or moderate (16/19) clinical types. Fever (15/19, 78.9%) and dry cough (11/19, 57.9%) were common symptoms. Two patients received negative results for more than three consecutive viral nucleic acid tests. The longest interval between an initial CT abnormal finding and a confirmed diagnosis was 30 days. One patient’s nucleic acid test turned positive on the follow-up examination after discharge. The presence of radiological abnormalities was non-specific for the diagnosis of COVID-19.
Conclusions COVID-19 patients with mild or no clinical symptoms are common in Beijing, China. Radiological abnormalities are mostly non-specific and massive CT examinations for COVID-19 screening should be avoided. Analyses of the contact histories of diagnosed cases in combination with clinical, radiological and laboratory findings are crucial for the early detection of COVID-19. Close monitoring after discharge is also recommended.

Key words: coronavirus, SARS-CoV-2, COVID-19, tomography, X-ray computed, follow-up

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