CAJ | 학술논문

目的分析人感染H7N9禽流感出院患者胸部CT表现和实验室结果,为H7N9感染影像学动态变化提供依据.方法收集上海市公共卫生临床中心收治的4例H7N9感染出院患者的临床及影像资料,分析影像学动态变化及与实验室结果的相关性.结果 4例患者从入院至出院行2～5次胸部CT检查,初次影像表现:3例以左肺下叶分布为主,1例主要分布于右肺下叶,病灶以磨玻璃密度(GGO)影为主;肺内病灶的影像表现呈多变性,吸收、进展交替出现,以GGO为主的病变均于治疗后平均3d左右可见明显吸收,3例以实变为主的病灶治疗后呈进展趋势,1例治疗后实变灶进展后逐渐吸收;1例出院后7d复查,肺内病灶明显吸收.肺内病灶进展趋势多对应血淋巴细胞绝对数和白细胞计数增加趋势.3例CD3、CD8、CD4、CD45绝对值同步减低,同时CD4/CD8比值均正常.结论 (1)H7N9感染引起的肺炎较为严重,病灶的影像表现多变,病灶总面积及其性质对决定预后有重要意义.(2)H7N9病毒感染可导致机体免疫功能抑制,血C反应蛋白的降低可预测病情的好转.
목적 분석인감염H7N9금류감출원환자흉부CT표현화실험실결과,위H7N9감염영상학동태변화제공의거.방법 수집상해시공공위생림상중심수치적4례H7N9감염출원환자적림상급영상자료,분석영상학동태변화급여실험실결과적상관성.결과 4례환자종입원지출원행2～5차흉부CT검사,초차영상표현:3례이좌폐하협분포위주,1례주요분포우우폐하협,병조이마파리밀도(GGO)영위주;폐내병조적영상표현정다변성,흡수、진전교체출현,이GGO위주적병변균우치료후평균3d좌우가견명현흡수,3례이실변위주적병조치료후정진전추세,1례치료후실변조진전후축점흡수;1례출원후7d복사,폐내병조명현흡수.폐내병조진전추세다대응혈림파세포절대수화백세포계수증가추세.3례CD3、CD8、CD4、CD45절대치동보감저,동시CD4/CD8비치균정상.결론 (1)H7N9감염인기적폐염교위엄중,병조적영상표현다변,병조총면적급기성질대결정예후유중요의의.(2)H7N9병독감염가도치궤체면역공능억제,혈C반응단백적강저가예측병정적호전.
Objective To analyze the laboratory results and chest CT appearances of novel recombinant avian-origin influenza A (H7N9) in discharged patients for understanding the imaging changes.Methods The clinical and imaging data of 4 patients with novel recombinant avian-origin influenza A (H7N9) were collected.The imaging changes and laboratory results were analyzed.Results All patients underwent chest CT examination 2 to 5 times from admission to discharge.The lesions primarily presented as ground-glass opacity (GGO) and mainly located in the inferior lobe of the left lung in 3 cases,in the inferior lobe of the right lung in 1 case,alternating between absorption and progress.GGO was absorbed obviously in about 3 days after treatment and consolidation was progressed after treatment.Consolidation absorption was observed with continue treatment in 1 case.The pulmonary lesions were absorbed obviously in 1 case 7 days after discharge.Synchronous reduction of the absolute values of CD3,CD8,CD4,CD45 were observed in 3 cases and the ratio of CD4/CD8 was normal.Conclusions (1) The areas of pulmonary involvement are large and variable in H7N9.The lesion area and imaging patterns are important for disease prognosis.(2) H7N9 virus infection may causes immunosuppression,decrease of CRP value can predict the improvement of the disease.