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妊娠中のCOVID-19のCT特性と診断値
CT characteristics and diagnostic value of COVID-19 in pregnancy.
PMID: 32614854 PMCID: PMC7331988. DOI: 10.1371/journal.pone.0235134.
抄録
目的:
妊娠中の新規コロナウイルス肺炎（NCPまたはCOVID-19）のコンピュータ断層撮影（CT）の特徴と診断値を調べる。
OBJECTIVE: To investigate the computed tomography (CT) characteristics and diagnostic value of novel coronavirus pneumonia (NCP or COVID-19) in pregnancy.
方法:
本研究は、2020年1月20日から2020年2月6日まで武漢大学中南病院で治療を受けたCOVID-19に感染した妊婦10名を対象とした。臨床および胸部CTデータを収集し、臨床症状、検査指標、CT画像を解析し、妊娠中のCOVID-19のCT特性と診断値を探った。
METHODS: This study included ten pregnant women infected with COVID-19, treated in the Zhongnan Hospital of Wuhan University from January 20, 2020 to February 6, 2020. Clinical and chest CT data were collected and clinical symptoms, laboratory indicators, and CT images were analyzed to explore CT characteristics and diagnostic value for COVID-19 during pregnancy.
結果:
臨床検査では、白血球数は9例で正常、1例でわずかに高値（10.23×109）であった。リンパ球比は2人の患者でそれぞれ12％、14％減少した。C反応性タンパク質のレベルは7人の患者で上昇し（範囲、21.16〜60.3mg/L）、Dダイマーのレベルは8人の患者で上昇した（範囲、507〜2141ng/mL）。6人の患者では総蛋白が低値であった（範囲，35.3～56.5mg/L）．2人の患者は単肺を巻き込んだ小さなパッチ状のグランドグラスオパチー（GGO）を示したが、8人の患者は部分的な圧密を伴って両肺に多葉性GGOを示した。末梢性および非末梢性の病変分布は、それぞれ10例（100％）および4例（40％）に認められた。肺内気管支前兆を認めた患者は4例、両側に小さな胸水を認めた患者は6例であったが、リンパ節腫脹を認めた患者は1例もいなかった。COVID-19投与後の動的観察は4例で実施した。そのうち1例は初診で正常を示し，3日後に新たな病変が認められた．1例は治療7日後に病変部の拡大を伴う進行が認められた．
RESULTS: Laboratory examination showed that white blood cell count was normal in nine patients, and slightly higher in one patient (10.23 × 109). The lymphocyte ratio decreased in two patients by 12% and 14%, respectively. The levels of C-reactive protein was elevated in seven patients (range, 21.16-60.3 mg/L) and the levels of D-dimer was increased in eight patients (range, 507-2141 ng/mL). Six patients had low levels of total protein (range, 35.3-56.5 mg/L). Two patients showed small patchy ground glass opacity (GGO) involving single lung, while eight patients showed multilobe GGO in both the lungs, with partial consolidation. Peripheral and non-peripheral lesion distributions were seen in ten (100%) and four (40%) patients, respectively. There were four patients who had signs of intra-bronchial air-bronchogram, six patients had small bilateral pleural effusions, while none had lymphadenopathy. Dynamic observations were performed in four patients after COVID-19 treatment. Among these four patients, one patient showed normal on the initial examination, and new lesions were observed after 3 days; 1 patient showed progression after 7 days of treatment, with expansion of the lesion area; and the other 2 patients showed improvement after 14 days of treatment, with reduction in the density and area of lesions and appearance of linear opacity.
結論:
妊娠中のCOVID-19のCT特徴は、主に初期および進行期に認められ、複数の新病変が共通していた。そして、病変内には大きさや程度の異なる癒合が認められた。さらに、元々のグランドガラス病変が融合したり、部分的に吸収されたりすることもあった。6人の患者には両側性の小さな胸水が認められた。まとめると、CTスキャンは、COVID-19が疑われる妊婦や確定症例の早期スクリーニング、動態観察、有効性評価において重要な役割を果たすことができる。
CONCLUSIONS: The CT characteristics of COVID-19 in pregnancy were mainly observed in early and progressive stages, and multiple new lesions were common. And there were consolidations of varying sizes and degrees within the lesion. Moreover, the original ground glass lesions could be fused or partially absorbed. Six patients had small bilateral pleural effusion. In summary, CT scans can play an important role in early screening, dynamic observation, and efficacy evaluation of suspected or confirmed cases of pregnant women with COVID-19.