放射学实践
放射學實踐
방사학실천
RADIOLOGIC PRACTICE
2014年
7期
756-759
,共4页
许少华%李宏军%李宁%胡春红%李润涛%齐石%李云芳%丁金立%张岩岩%米海峰%张琦%柳娇娇
許少華%李宏軍%李寧%鬍春紅%李潤濤%齊石%李雲芳%丁金立%張巖巖%米海峰%張琦%柳嬌嬌
허소화%리굉군%리저%호춘홍%리윤도%제석%리운방%정금립%장암암%미해봉%장기%류교교
禽流感%甲型流感%肺炎%体层摄影术,X线计算机
禽流感%甲型流感%肺炎%體層攝影術,X線計算機
금류감%갑형류감%폐염%체층섭영술,X선계산궤
Influenza in birds%Influenza A%Pneumonia%Tomography,X-ray computed
目的：比较人感染 H7N9禽流感与甲型 H1N1流感重症肺炎的临床及 CT 影像学特点。方法：回顾性分析12例人感染 H7N9禽流感（H7N9组）和21例甲型 H1N1流感重症肺炎患者（H1N1组）的临床表现、并发症及治疗转归和CT影像学资料。结果：H7N9组基础疾病和进入 ICU 接受治疗的比例均高于 H1N1组（χ2＝3．111，P＜0．05；χ2＝3．599，P＜0．05））。H7N9组发病初期伴有呼吸困难和气促、呼吸窘迫综合症的发生率均高于 H1N1组（双侧P＜0．001；χ2＝3．111，P＜0．05）。H7N9组患者有创机械通气治疗和死亡率均高于 H1N1病毒感染组（χ2＝7．219，P＜0．01；双侧P＜0．05）。两组流感患者主要病理表现为肺间质和实质损伤，其基本 CT 影像改变是肺内磨玻璃密度影和肺实变密度影。H7N9组患者胸腔积液和网格状密度增高表现多于 H1N1组（双侧P＜0．05）。结论：与 H1N1组患者相比，H7N9组患者基础疾病多、病情进展更为迅猛、并发症更为严重、死亡率更高。CT检查能客观反映二者的影像特征，有助于指导临床治疗和疗效评估，但仅凭CT影像资料不能对二者进行鉴别诊断。
目的：比較人感染 H7N9禽流感與甲型 H1N1流感重癥肺炎的臨床及 CT 影像學特點。方法：迴顧性分析12例人感染 H7N9禽流感（H7N9組）和21例甲型 H1N1流感重癥肺炎患者（H1N1組）的臨床錶現、併髮癥及治療轉歸和CT影像學資料。結果：H7N9組基礎疾病和進入 ICU 接受治療的比例均高于 H1N1組（χ2＝3．111，P＜0．05；χ2＝3．599，P＜0．05））。H7N9組髮病初期伴有呼吸睏難和氣促、呼吸窘迫綜閤癥的髮生率均高于 H1N1組（雙側P＜0．001；χ2＝3．111，P＜0．05）。H7N9組患者有創機械通氣治療和死亡率均高于 H1N1病毒感染組（χ2＝7．219，P＜0．01；雙側P＜0．05）。兩組流感患者主要病理錶現為肺間質和實質損傷，其基本 CT 影像改變是肺內磨玻璃密度影和肺實變密度影。H7N9組患者胸腔積液和網格狀密度增高錶現多于 H1N1組（雙側P＜0．05）。結論：與 H1N1組患者相比，H7N9組患者基礎疾病多、病情進展更為迅猛、併髮癥更為嚴重、死亡率更高。CT檢查能客觀反映二者的影像特徵，有助于指導臨床治療和療效評估，但僅憑CT影像資料不能對二者進行鑒彆診斷。
목적：비교인감염 H7N9금류감여갑형 H1N1류감중증폐염적림상급 CT 영상학특점。방법：회고성분석12례인감염 H7N9금류감（H7N9조）화21례갑형 H1N1류감중증폐염환자（H1N1조）적림상표현、병발증급치료전귀화CT영상학자료。결과：H7N9조기출질병화진입 ICU 접수치료적비례균고우 H1N1조（χ2＝3．111，P＜0．05；χ2＝3．599，P＜0．05））。H7N9조발병초기반유호흡곤난화기촉、호흡군박종합증적발생솔균고우 H1N1조（쌍측P＜0．001；χ2＝3．111，P＜0．05）。H7N9조환자유창궤계통기치료화사망솔균고우 H1N1병독감염조（χ2＝7．219，P＜0．01；쌍측P＜0．05）。량조류감환자주요병리표현위폐간질화실질손상，기기본 CT 영상개변시폐내마파리밀도영화폐실변밀도영。H7N9조환자흉강적액화망격상밀도증고표현다우 H1N1조（쌍측P＜0．05）。결론：여 H1N1조환자상비，H7N9조환자기출질병다、병정진전경위신맹、병발증경위엄중、사망솔경고。CT검사능객관반영이자적영상특정，유조우지도림상치료화료효평고，단부빙CT영상자료불능대이자진행감별진단。
Objective:To compare the CT characteristics and clinical course in patients with severe pneumonia due to avian influenza H7N9 and swine influenza H1N1 infection.Methods:The materials of epidemiology,serology,clinical mani-festations,complications,treatment outcome and CT findings of severe pneumonia in 21 patients with influenza A (H1N1) and 12 patients with influenza H7N9 were retrospectively analyzed.Results:The age of H7N9 patients were older and they had more basic diseases (χ2= 3.111,P<0.05).In addition,the proportion of ICU treatment in H7N9 patients was higher than that in H1N1 patients (χ2= 3.599,P<0.05).The onset symptoms of the 2 groups were fever and cough,and might be accompanied by running nose,expectoration,fatigue,nausea,vomiting,diarrhea and abdominal pain.Moist rales and wheezing sound could be assessed on auscultation.Bloody or rusty sputum in H7N9 infections was more observed than that in H1N1 (P<0.05).Dyspnea and shortness of breath in H7N9 infections were more (P<0.001),as well as the incidence of complicated acute ARDS was higher (χ2= 3.111,P<0.05).Treatment with invasive mechanical ventilation as well as mortality were higher in H7N9 group compared with that of H1N1 group (χ2= 7.219,P<0.01;P<0.05).In both two groups,the major pathology was invasion of pulmonary parenchyma and interstitial tissue.The fundamental pulmonary CT findings were pulmonary ground-glass opacities (GGOs)and consolidations,often associated with air bronchogram;inter-lobular septum thickening,bronchiectasis,lymph node enlargement or pleural effusion could also be revealed.Pleural effu-sion and reticular appearance of lung in H7N9 group were more observed than that in H1N1 group (P<0.05).Conclusion:Compared with influenza A (H1N1)patients,H7N9 patients were older in age,with more basic diseases,serious complica-tions and more rapid progression of disease,mortality was higher as well.CT not only could display objectively the imaging characteristics of the two disease entities,but also is helpful in treatment guidance and prognosis prediction.However,only depends on CT findings,differential diagnosis of the two diseases could not be made.
