摘要
目的回顾性分析老年新型冠状病毒肺炎(COVID-19)病人临床和肺部CT变化特点。方法将31例确诊为COVID-19的老年病人(男13例,女18例)分成普通组(16例,52%)和重症组(15例,48%)。回顾性分析病人临床特征、实验室检查和动态CT影像的变化。根据每次CT的肺叶受累百分比进行半定量评分,总结病人CT变化特点。结果老年COVID-19病人首诊最常见的症状是发烧(68%)和咳嗽(52%)。重症组病人平均年龄(73.13±7.12)岁,普通组病人平均年龄(67.75±5.31)岁,差异有统计学意义(P<0.05)。31例病人总共进行了172次扫描,平均扫描(5.55±1.15)次,平均胸部CT评分为(8.19±5.60)分。病变高峰期出现在发病后(10.23±8.11)d。重症组病人峰值CT评分高于普通组,差异有统计学意义(P=0.02)。重症组病人末次CT评分高于普通组,差异有统计学意义(P=0.01)。肺部CT病变范围评分变化模式包括4种类型进展-高峰-吸收型、逐渐吸收型、平台型和持续进展型。早期CT病变分布以胸膜下多见,共13例(42%);峰值CT多为双肺弥漫性病变,共18例(58%),其中3例(10%)呈现“白肺”。8例首次CT为散在分布中的6例(75%)在峰值CT上表现为弥漫性分布。结论老年COVID-19重症和危重型病人比普通型病人年龄大、肺部病变范围大;老年病人肺炎吸收慢,病程超过30 d。老年病人高峰期肺部病变以弥漫性分布为主。
Objective To retrospectively analyze the clinical characteristics and chest computed tomography(CT)dynamic changes of the elderly patients with COVID-19.Methods A total of 31 elderly patients who were diagnosed as COVID-19 were divided into non-severe group(n=16,52%)and severe group(n=15,48%).The clinical characteristics,laboratory tests,and dynamic CT results were retrospectively analyzed.According to the percentage of involved lung lobes,CT semi-quantitative scoring was performed to assess the dynamic CT changes.Results The most common symptoms of COVID-19 were fever(n=21,68%)and cough(n=16,52%).The severe group was significantly older than the non-severe group(P=0.023).A total of 172 times of CT scanning were performed in 31 patients with COVID-19,with a mean value of 5.55±1.15,and with a mean chest CT score of 8.19±5.60.The peak time of disease appeared on day 10.23±8.11 after illness onset.The peak CT score of severe group(15.13±6.07)was significantly higher than that of non-severe group(9.88±5.48).The last CT score of severe group(10.00±7.29)was higher than that of non-severe group(4.38±3.22).There were four patterns of changes in lung CT score including initial deterioration to peak level involvement followed by improvement pattern,gradual absorption pattern,progressive deterioration pattern and plateau pattern.The distribution of early lesions in the first CT scan was mostly subpleural area(n=13,42%),while diffuse lesions were found in both lungs in the peak CT(n=18,58%),and 3 cases(10%)showed"white lung".In addition,6 out of 8 cases(75%)with scattered distribution of lung lesions in the first CT scan showed diffuse distribution in the peak CT.Conclusions There are older age and larger range of lung lesions in the elderly patients with severe and critical disease than the non-severe patients.The course of pneumonia in the elderly patients tends to be longer than 30 days.The distribution of lesions at peak in the elderly patients with COVID-19 is mainly diffused.
作者
刘松
聂陈
余成新
LIU Song;NIE Chen;YU Cheng-xin(Department of Radiology,Yichang Central People’s Hospital,the First College of Clinical Medical Science,China Three Gorges University,Yichang 443003,China;Department of Radiology,Yichang Second People’s Hospital,Yichang 443001,China)
出处
《实用老年医学》
CAS
2020年第9期988-992,共5页
Practical Geriatrics
