标题：新型冠状病毒肺炎CT肺部炎症指数分级的临床应用价值

      作者：苏丽平 1，李晓燕 1，杨全 1，王兴兰 1，应洁 1，廖娟 2，胡勇 1    重庆医科大学附属永川医院放射科 1、中心实验室 2，重庆 402160

      卷次： 2020年31卷18期

      【摘要】 目的 探讨新型冠状病毒肺炎(COVID-19)患者CT肺部炎症指数分级的临床应用价值。方法 回顾性分析2020年1~2月重庆医科大学附属永川医院收治的50例COVID-19患者胸部CT平扫图像和临床资料。根据5阶法对肺部病灶进行分级，其中0级4例，Ⅰ级27例，Ⅱ级12例，Ⅲ级7例，并统计分析临床特征及CT表现，采用 Spearman秩相关分析CT肺部炎症指数分级与临床分型的相关性。结果 50例COVID-19确诊患者中 49例(98.0%)有明确武汉接触史；发热(68.0%)及咳嗽(42.0%)是最常见的临床症状；炎症指数Ⅱ级、Ⅲ级患者体温高于0级、Ⅰ级患者，差异均具有统计学意义(P<0.05)；实验室检查，44例白细胞计数正常，41例中性粒细胞百分比数正常，29例淋巴细胞计数降低，28例超敏C反应蛋白水平升高，38例血沉升高；CT肺部炎症指数分级越高者淋巴细胞计数降低越明显，差异具体统计学意义(P<0.05)，CT肺部炎症指数分级越高者血沉和中性粒细胞百分比越高，差异具有统计学意义(P<0.05)；炎症指数Ⅰ~Ⅲ级患者肺部CT表显示病灶多累及双肺，其中Ⅰ级COVID-19患者中8例为单发病灶、19例累及双肺；随炎症指数分级升高，肺部病灶由胸膜下转变为内带支气管束周围，且肺部病灶实变增多，差异具有统计学意义(P<0.05)；相关性分析结果显示，COVID-19患者CT肺部炎症指数分级与临床分型呈正相关(r=0.701，P<0.05)；4例 0级均为轻型，27例Ⅰ级、11例Ⅱ级、1例Ⅲ级均为普通型，1例Ⅱ级、6例Ⅲ级为重型。结论 COVID-19患者胸部 CT表现具有特征性，CT肺部炎症指数分级与临床分型呈显著正相关，能对其肺部炎症严重程度进行定量评估，此外，胸部CT能早期诊断COVID-19。
      【关键词】 新型冠状病毒肺炎；肺部炎症指数；CT表现；临床分型；定量评估
      【中图分类号】 R515 【文献标识码】 A 【文章编号】 1003—6350（2020）18—2389—04

Clinical application value of pulmonary inflammation index (PII) grades of CT in patients with corona virusdisease 2019.
SU Li-ping 1, LI Xiao-yan 1, YANG Quan 1, WANG Xing-lan 1, YING Jie 1, LIAO Juan 2, HU Yong 1.Department of Radiology 1, Central Laboratory 2, Yongchuan Hospital of Chongqing Medical University, Yongchuan 402160,Chongqing, CHINA
【Abstract】 Objective To explore the clinical application value of pulmonary inflammation index (PII) gradesin patients with corona virus disease 2019 (COVID-19). Methods CT findings and clinical characteristics of 50 pa-tients with COVID-19 in Yongchuan Hospital of Chongqing Medical University from January 2020 to February 2020were retrospectively analyzed. Pulmonary lesions were graded according to 5-stage method, including 4 cases of grade0, 27 cases of gradeⅠ, 12 cases of gradeⅡ, and 7 cases of gradeⅢ. The clinical features and CT findings were statisti-cally analyzed, and Spearman rank correlation analysis was used to analyze the correlation between pulmonary inflam-mation index grade (PⅡ) and clinical typing. Results Among the 50 patients diagnosed with COVID-19, 49 (98.0%)had a clear history of exposure to Wuhan. Fever (68.0%) and cough (42.0%) were the most common clinical symptoms.The temperature of inflammation index Ⅱ grade, Ⅲ grade were higher than that of 0 grade, Ⅰgrade patients (P<0.05).Laboratory results showed that white blood cell count is normal in 44 cases (88%), neutrophil percentage is normal in 41cases, lymphocyte count is decreased in 29 cases, hypersensitive C-reactive protein levels were increased in 28 patients,and erythrocyte sedimentation rate was increased in 38 patients. The higher the pulmonary inflammatory index on CT,the more the lymphocyte count decreased and the higher the erythrocyte sedimentation rate and percentage of neutro-phils (P<0.05). The lung CT of patients of inflammation index Ⅰ-Ⅲ grade showed that lung lesions were mostly in-volved both lungs, with 8 cases ofⅠ grade involving single lesion and 19 cases involving both lungs. With the increaseof inflammatory index grade, the pulmonary lesions were transformed from subpleural to peribronchial tract, and the con-solidation of pulmonary lesions increased (P<0.05). Correlation analysis showed that pulmonary inflammation indexgrades was positively correlated with clinical types (r=0.701, P<0.05): the 4 cases of grade 0 were mild type; 27 cases ofgradeⅠ, 11 cases of gradeⅡ, and 1 case of gradeⅢ were normal type; 1 case of gradeⅡ, 6 cases of gradeⅢ were se-vere type. Conclusion CT findings of patients with COVID-19 are typical，and pulmonary inflammation index (PⅡ)grades of CT had significant positive correlation with clinical classification, which can quantitatively assess the severityof lung inflammation. Beside, chest CT can be used for the early diagnosis of COVID-19.
      【Key words】 COVID-19; Pulmonary inflammation index; CT findings; Clinical classification; Quantitative eval-uation