南京大学学报(自然科学版) ›› 2020, Vol. 56 ›› Issue (3): 430–436.doi: 10.13232/j.cnki.jnju.2020.03.011

• • 上一篇    

COVID⁃19的临床和影像特征与试行指南的映证分析

汪洋1,陈泰格2,陆晓凡3,4,辛小燕1,王坤1,李茗1,青钊1,张英为5,严晓敏6,吴超6,言方荣3,4,张冰1()   

  1. 1.南京大学医学院附属鼓楼医院影像科,南京,210008
    2.南京大学医学院,南京,210008
    3.天然药物国家重点实验室,中国药科大学,南京,210009
    4.中国药科大学生物统计与计算药学研究中心,南京,210009
    5.南京大学医学院附属鼓楼医院呼吸科,南京,210008
    6.南京大学医学院附属鼓楼医院感染科,南京,210008
  • 收稿日期:2020-04-27 出版日期:2020-05-30 发布日期:2020-06-03
  • 通讯作者: 张冰 E-mail:zhangbing_nanjing@vip.163.com
  • 基金资助:
    江苏省科技计划项目社会发展课题(BE2017707);南京大学“新型冠状病毒肺炎(NCP)应急科研专项”,中央高校基本科研业务费专项资金(021414380462)

Correlation analysis between clinical and imaging characteristics and pilot guidelines of COVID⁃19: A survey of a large designated hospital after the lockdown of Wuhan

Yang Wang1,Taige Chen2,Xiaofan Lu3,4,Xiaoyan Xin1,Kun Wang1,Ming Li1,Zhao Qing1,Yingwei Zhang5,Xiaomin Yan6,Chao Wu6,Fangrong Yan3,4,Bing Zhang1()   

  1. 1.Department of Radiology,The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing,210008,China
    2.Medical School of Nanjing University,Nanjing,210008,China
    3.State Key Laboratory of Natural Medicines,China Pharmaceutical University,Nanjing,210009, China
    4.Research Centre of Biostatistics and Computational Pharmacy,China Pharmaceutical University,Nanjing,210009,China
    5.Department of Respiratory,The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing,210008,China
    6.Department of Infection,The Affiliated Nanjing Drum Tower Hospital of Nanjing University Medical School,Nanjing,210008,China
  • Received:2020-04-27 Online:2020-05-30 Published:2020-06-03
  • Contact: Bing Zhang E-mail:zhangbing_nanjing@vip.163.com

摘要:

旨在分析在关闭离汉通道这类强有力的切断传染途径的干预措施下,新型冠状病毒肺炎(Corona Virus Disease 2019,COVID?19)在南京地区代表性定点医院的流行病学、临床、影像学的特点及发展趋势,并与国家卫生健康委员会发布的《新型冠状病毒感染的肺炎诊疗方案(试行第五版)》(简称诊疗指南)进行对照.发现:COVID?19在医院/家庭环境中的人际传播在关闭离汉通道后的武汉以外的地区依旧存在;随着时间的推移,本定点收治医院的患者存在区域病患数目下降的趋势;无论是否有流行病学病史,影像学上均呈现肺外周带为主的多发磨玻璃样病变或者结节状病变.利用胸部CT特征性表现来诊断COVID?19的价值较高,可以发挥快速和准确诊断的重要作用,与现行的诊疗指南中将其作为重要诊断证据的指导意见相符.

关键词: 新型冠状病毒肺炎, SARS?CoV?2, 切断传染途径, 电子计算机断层扫描

Abstract:

With the loockdown of Wuhan,which is a powerful way to cut off the transmission route,we aim to study the epidemiological,clinical and imaging characteristics and trends of Corona Virus Disease 2019 (COVID?19) in Nanjing,and furtherly compare them with Chinese management guideline for COVID?19 (version 5.0) published by National Health Commission of the People's Republic of China (simply called “the diagnostic guidelines”). This study involved all the general data of patients admitted to a local designated hospital in Nanjing since January 23,2020. Infection?confirmed patients were divided into four groups according to the epidemic history. We analyzed the epidemiological,clinical,laboratory and radiological features of all patients and compared the results with the current diagnostic guidelines. There were 143 patients admitted. The sensitivity of chest CT scan diagnosis is 91.67% while the specificity is 99.21%. The distribution of age of the 12 cases was 47±14.6 years and cough was the major clinical manifestation (33%). There are no new confirmed cases since February 3,2020. We concluded: the human?to?human transmission of novel coronavirus in a nosocomial/family environment still exists,the number of patients admitted to hospital tends to decrease,the imaging presents multiple ground?glass lesions or nodular lesions dominated by the peripheral lung zone whatever the epidemic history,chest CT scan diagnosis is of high value on COVID?19 since it is quick and specific,and current guidelines are generally consistent with clinical practice. We recommend to simplify laboratory examinations and lay more emphasis on imaging diagnosis.

Key words: COVID?19, SARS?CoV2, cut?off of transmission routes, computed tomography

中图分类号: 

  • R184

表1

143例患者的胸部CT诊断结果(与RT?PCR检测结果对照)"

胸部CT诊断咽拭子病毒核酸RT?PCR检测合计
阳性阴性
敏感性=11/12=91.67%,特异性=126/127=99.21%
疑似11516
排除1126127
合计12131143

表2

12名确诊COVID?19患者的临床特征和胸部CT信息"

P1P2P3P4P5P6P7P8P9P10P11P12平均值
年龄(岁)30312761596441325654623447
体温(°C)38.337.8NA36.237.838.737.937.537.6NA37.539.137.8
性别

男/女

7/5

临床表现

阳性

比例

咳嗽+-++--+-----33%
肌肉酸痛----+--+----17%
乏力+-----------8%
咽痛---+--+-----17%
胸闷+---+-------17%
消化道症状------------0%
其他鼻塞流涕畏寒
咽拭子病毒核酸检测++++++++++++100%
CT征象

平均值

(个)

病变主要类型

磨玻璃样

斑片影

磨玻

璃影

实变与斑片影

结节

样影

磨玻

璃影

磨玻

璃影

结节样与

磨玻璃影

结节

样影

网格与斑片影大片磨玻璃影大片磨玻璃影
病变数目(个)1011141520014215
临床分型普通型普通型普通型普通型普通型普通型普通型普通型普通型普通型普通型普通型

图1

12名确诊患者的流行病学史、临床症状和重要事件在时间轴上的汇总"

图2

第一组患者的胸部CT影像"

1 武汉10时起暂时关闭机场火车站离汉通道. https:∥www.shobserver.com/journal/2020?01?23/getArticle.htm?id=286832,2020-01-23.
2 Huang C L,Wang Y M,Li X W,et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China. The Lancet,2020,395(1022):497-506.
3 Chan J F W,Yuan S,Kok K H,et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person?to?person transmission:a study of a family cluster. The Lancet,2020,395(10223):514-523.
4 新型冠状病毒感染的肺炎诊疗方案(试行第五版)解读. http:∥www.gov.cn/zhengce/2020?02/05/content_5474852.htm,2020-02-05.
5 Li Q,Guan X H,Wu P,et al. Early transmission dynamics in wuhan,China,of novel coronavirus–infected pneumonia. New England Journal of Medicine,2020,382(13):1199-1207.
6 新型冠状病毒肺炎的放射学诊断:中华医学会放射学分会专家推荐意见(第一版). 中华放射学杂志,2020,54:E001.
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8 Wang D W,Hu B,Hu C,et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan,China. JAMA(The Journal of the American Medical Association),2020,doi:10.1001/jama.2020.1585.
doi: 10.1001/jama.2020.1585
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