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臨床型の異なるコロナウイルス疾患2019（COVID-19）患者の臨床的特徴とCT撮影特徴について
[Clinical characteristics and CT imaging features of patients with different clinical types of coronavirus disease 2019].
PMID: 32576345 DOI: 10.3760/cma.j.cn121430-20200323-00203.
抄録
目的:
異なる臨床型のコロナウイルス疾患2019（COVID-19）を有する患者の臨床的特徴とCT画像特徴を調査し、COVID-19の治療・評価の参考とすること。
OBJECTIVE: To investigate the clinical characteristics and CT imaging features of patients with different clinical types of coronavirus disease 2019 (COVID-19), so as to provide a reference for the treatment and evaluation of COVID-19.
方法:
2020年1月20日から2月10日までに広州第八人民病院に入院したCOVID-19患者278人の臨床データを収集した。患者を軽症型、普通型、重症型、重症型に分けた。異なる臨床型における肺の臨床症状や徴候、臨床検査指標、CT画像特徴の違いを分析・比較し、臨床・画像特徴と臨床型との関係を分析した。
METHODS: The clinical data of 278 patients with COVID-19 admitted to Guangzhou Eighth People's Hospital from January 20th to February 10th in 2020 were collected. The patients were divided into mild, ordinary, severe and critical types. The differences of clinical symptoms and signs, laboratory examination indexes and CT image features of lung in different clinical types were analyzed and compared, and the relationship between clinical and imaging features and clinical types of diseases were analyzed.
結果:
COVID-19患者278人のうち、男性130人（46.8％）、女性148人（53.2％）で、そのうち88.8％（247人/278人）は20～69歳であった。238例（85.6％）は1つ以上の基礎疾患を合併していた。症例の出所は主に輸入症例（n=201、72.3％）であり、そのうち武漢からの輸入症例は89例で、輸入症例全体の44.3％を占めていた。疾患の悪化に伴い、男性の構成比、年齢、患者の基礎疾患数が徐々に増加し、重症・重症患者の発熱、空咳、寒気・悪寒、倦怠感の発生率は軽症・普通患者に比べて有意に高かった。また、重症・重症患者の白血球数（WBC）、好中球数（NEU）及びその割合（NEU％）は軽症・普通患者に比べて高かった［WBC（×10/L）：5．7±3.1、6.5±2.4 vs. 5.4±1.7、4.9±1.6; NEU(×10/L): 4.4±3.1、4.9±2.5 vs. 2.8±1.2、2.9±1.3; NEU%.0.72±0.13、0.73±0.14 vs. 0.51±0.12、0.59±0.11；すべてP＜0。01]、リンパ球数(LYM)と比率(LYM%)、血小板数(PLT)は軽症者と普通者に比べて低かった[LYM(×10/L): 1.0±0.4、1.2±0.8 vs. 2.1±0.9、1.5±0.6; LYM%.0.21±0.11、0.20±0.12 vs. 0.40±0.11、0.32±0.11；PLT（×10/L）：177.1±47.8、157.7±51.6 vs. 215.3±59.7、191.8±64.3；すべてP＜0.05］。重症患者ではアルブミン（Alb）が最も低く，総ビリルビン（TBil）が最も高く，軽症，普通，重症患者と比較して統計学的に有意であった［Alb（g/L）：33．0±5.8 vs. 42.8±4.4，39.6±5.1，34.4±4.2；TBil（μmol/L）：20.1±12.8 vs. 12.0±8.7，10.9±6.3，12.2±8.3；いずれもP＜0.01］であった。重症・重症患者の乳酸脱水（LDH）および心筋トロポニンI（cTnI）は、軽症・普通患者に比べて有意に高かった［LDH（μmol×s×L）：5．6±2.2、5.0±2.9 vs. 2.8±0.9、3.3±1.2；cTnI（μg/L）：0.010（0.006、0.012）、0.010（0.006、0.012） vs. 0.005（0.003、0.006）、0.005（0.001、0.008）；いずれもP＜0.05］。重症患者のC反応性蛋白（CRP）値は，軽症，普通，重症患者よりも高かった［mg/L：43.3（33.2，72.1）対22.1（16.2，25.7），29.7（19.8，43.1），25.8（23.0，36.7），P＜0.01］．重症・重症患者のプロカルシトニン（PCT）レベルは、軽症・一般患者よりも高かった［μg/L：0.17（0.12、0.26）、0.13（0.09、0.24）対0.06（0.05、0.08）、0.05（0.04、0.09）、P＜0.01］。典型的なCT画像の特徴は、普通型では胸部画像上に単数または複数のグランドガラス影が主に認められ、重症型では複数のグランドガラス影、浸潤影または固体変態影が主に認められた。普通型に比べて病変が増加し、病変範囲が拡大して二重肺を示すようになった。重症型は主に両肺のびまん性圧密として複数のパッチ状密度増加影を呈し、各葉に複数の葉状パッチ状密度増加影を認め、その多くは地上ガラス状密度であり、一部は別々に肺圧密を示すものもあった。
RESULTS: Among the 278 patients with COVID-19, 130 were male (46.8%) and 148 were female (53.2%), of whom 88.8% (247/278) were 20 to 69 years old. 238 (85.6%) patients combined one or more basic diseases. The source of cases was mainly imported cases (n = 201, 72.3%), of whom 89 cases were imported from Wuhan, accounting for 44.3% of all imported cases. With the aggravation of the disease, the male composition ratio, age and the number of basic diseases of patients gradually increased, and the incidences of fever, dry cough, chilly or chills, and fatigue in severe and critical patients were significantly higher than those in the mild and ordinary ones. The white blood cell count (WBC), neutrophil counts (NEU) and proportions (NEU%) of the severe and critical patients were higher than those of the mild and ordinary patients [WBC (×10/L): 5.7±3.1, 6.5±2.4 vs. 5.4±1.7, 4.9±1.6; NEU (×10/L): 4.4±3.1, 4.9±2.5 vs. 2.8±1.2, 2.9±1.3; NEU%: 0.72±0.13, 0.73±0.14 vs. 0.51±0.12, 0.59±0.11; all P < 0.01], while the lymphocyte count (LYM) and ratio (LYM%), platelet count (PLT) were lower than those in the mild and ordinary patients [LYM (×10/L): 1.0±0.4, 1.2±0.8 vs. 2.1±0.9, 1.5±0.6; LYM%: 0.21±0.11, 0.20±0.12 vs. 0.40±0.11, 0.32±0.11; PLT (×10/L): 177.1±47.8, 157.7±51.6 vs. 215.3±59.7, 191.8±64.3; all P < 0.05]. The level of albumin (Alb) was the lowest in the critical patients and the level of total bilirubin (TBil) was the highest, which was statistically significant as compared with the mild, ordinary and severe patients [Alb (g/L): 33.0±5.8 vs. 42.8±4.4, 39.6±5.1, 34.4±4.2; TBil (μmol/L): 20.1±12.8 vs. 12.0±8.7, 10.9±6.3, 12.2±8.3; both P < 0.01]. Lactate dehydration (LDH) and cardiac troponin I (cTnI) in the severe and critical patients were significantly higher than those in the mild and ordinary patients [LDH (μmol×s×L): 5.6±2.2, 5.0±2.9 vs. 2.8±0.9, 3.3±1.2; cTnI (μg/L): 0.010 (0.006, 0.012), 0.010 (0.006, 0.012) vs. 0.005 (0.003, 0.006), 0.005 (0.001, 0.008); both P < 0.05]. C-reactive protein (CRP) level of severe patients were higher than that in the mild, ordinary and critical patients [mg/L: 43.3 (33.2, 72.1) vs. 22.1 (16.2, 25.7), 29.7 (19.8, 43.1), 25.8 (23.0, 36.7), P < 0.01]. The level of procalcitonin (PCT) in the severe and critical patients was higher than that in the mild and ordinary patients [μg/L: 0.17 (0.12, 0.26), 0.13 (0.09, 0.24) vs. 0.06 (0.05, 0.08), 0.05 (0.04, 0.09), P < 0.01]. The typical CT imaging features were as follows: the ordinary type mainly showed the single or multiple ground glass shadows on the chest image; the severe type mainly showed the multiple ground glass shadows, infiltration shadows or solid transformation shadows. Compared with the ordinary patients, the lesions increase, and the scope of the lesion expanded to show double lungs. Critical type was mainly manifested as diffuse consolidation of both lungs with multiple patchy density increase shadows, multiple leafy patchy density increase shadows were seen on each leaf, most of them were ground glass-like density, and some were shown separately lung consolidation.
結論:
男性、高齢者、複数の基礎疾患を合併している人はCOVID-19のハイリスク集団であり、重症・重症型への進行リスクに注意を払う必要がある。重症・重症のCOVID-19を診断する際には、CT画像の特徴が重要な補足として利用される可能性がある。
CONCLUSIONS: Men, advanced aged, and combining multiple underlying diseases are high-risk populations of COVID-19, and they should pay close attention to the risk of progressing to severe or critical type. CT imaging features could be used as an important supplement when diagnosing severe and critical COVID-19.