Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children
Clinical and CT imaging features of the COVID-19 pneumonia: Focus on pregnant women and children
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DOI：
10.1016/j.jinf.2020.03.007
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发表时间：
2020-05-01
影响因子：
28.2
通讯作者：
Lan, Weishun
中科院分区：
文献类型：
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作者：
Liu, Huanhuan;Liu, Fang;Lan, Weishun
背景：正在发生的COVID-19肺炎疫情引起全球关注。我们的目的是探讨孕妇和儿童患此病的临床和CT特征，这些疾病尚未得到很好的报道。方法：回顾性分析2020年1月27日至2月14日59例COVID-19患者的临床和CT资料，其中实验室确诊的未妊娠成人14例，实验室确诊的孕妇16例，临床诊断的孕妇25例，实验室确诊的儿童4例。分析比较临床及CT表现。结果：与未妊娠成人组（n = 14）相比，实验室确诊（n = 16）和临床诊断（n = 25）妊娠组的初始体温正常（9例[56%]和16例[64%]）、白细胞增多（8例[50%]和9例[36%]）、中性粒细胞比例升高（14例[88%]和20例[80%]）和淋巴细胞减少（9例[56%]和16例[64%]）更为常见。总共检测到614个病变，分别为54例（98%）和37例（67%），主要分布在周围和双侧。纯磨玻璃混浊（GGO）主要存在于94/131（72%）的非怀孕成人病变中。混合实变和完全实变在实验室确诊的妊娠组（70/161[43%]）和临床诊断的妊娠组（153/322[48%]）较在非妊娠成人(37/131（28%）中更为常见（P = 0.007, P < 0.001）。两组妊娠组GGO网状病变发生率分别为9/161（6%）和16/322(5%)，低于未妊娠组的24/131 (18%)（P = 0.001, P < 0.001）。COVID-19患儿肺部受累较轻，伴有局灶性GGO或实变。23例患者接受了随访CT，在初始CT扫描后的第3天，9/13（69%）出现进展，而在第6-9天，8/10（80%）出现改善。结论：新冠肺炎孕妇临床表现不典型，增加初步识别难度。合并在孕妇组中更为常见。临床诊断的病例更容易累及肺部。对于有或无实验室确诊的COVID-19流行特征和临床特征的病例，CT是早期发现、严重程度评估和及时疗效评估的首选方式。与胸部CT相比，暴露史和临床症状对儿童筛查更有帮助。(C) 2020作者。由爱思唯尔有限公司代表英国感染协会出版。
Background: The ongoing outbreak of COVID-19 pneumonia is globally concerning. We aimed to investigate the clinical and CT features in the pregnant women and children with this disease, which have not been well reported.Methods: Clinical and CT data of 59 patients with COVID-19 from January 27 to February 14, 2020 were retrospectively reviewed, including 14 laboratory-confirmed non-pregnant adults, 16 laboratory-confirmed and 25 clinically-diagnosed pregnant women, and 4 laboratory-confirmed children. The clinical and CT features were analyzed and compared.Findings: Compared with the non-pregnant adults group (n = 14), initial normal body temperature (9 [56%] and 16 [64%]), leukocytosis (8 [50%] and 9 [36%]) and elevated neutrophil ratio (14 [88%] and 20 [80%]), and lymphopenia (9 [56%] and 16 [64%]) were more common in the laboratory-confirmed (n = 16) and clinically-diagnosed (n = 25) pregnant groups. Totally 614 lesions were detected with predominantly peripheral and bilateral distributions in 54 (98%) and 37 (67%) patients, respectively. Pure ground-glass opacity (GGO) was the predominant presence in 94/131 (72%) lesions for the non-pregnant adults. Mixed consolidation and complete consolidation were more common in the laboratory-confirmed (70/161 [43%]) and clinically-diagnosed (153/322 [48%]) pregnant groups than 37/131 (28%) in the non-pregnant adults (P = 0.007, P < 0.001). GGO with reticulation was less common in 9/161 (6%) and 16/322 (5%) lesions for the two pregnant groups than 24/131 (18%) for the non-pregnant adults (P = 0.001, P < 0.001). The pulmonary involvement in children with COVID-19 was mild with a focal GGO or consolidation. Twenty-three patients underwent follow-up CT, revealing progression in 9/13 (69%) at 3 days whereas improvement in 8/10 (80%) at 6-9 days after initial CT scans.Interpretation: Atypical clinical findings of pregnant women with COVID-19 could increase the difficulty in initial identification. Consolidation was more common in the pregnant groups. The clinically-diagnosed cases were vulnerable to more pulmonary involvement. CT was the modality of choice for early detection, severity assessment, and timely therapeutic effects evaluation for the cases with epidemic and clinical features of COVID-19 with or without laboratory confirmation. The exposure history and clinical symptoms were more helpful for screening in children versus chest CT. (C) 2020 The Author(s). Published by Elsevier Ltd on behalf of The British Infection Association.