郑敬, 赵鹏, 刘慧莹, 何园, 秦艳红, 杨宁, 张越, 王海霞, 柏长青. COVID-19患者康复早期临床特征、肺功能及影像学随访[J]. 解放军医学院学报, 2021, 42(4): 368-371, 406. DOI: 10.3969/j.issn.2095-5227.2021.04.002
引用本文: 郑敬, 赵鹏, 刘慧莹, 何园, 秦艳红, 杨宁, 张越, 王海霞, 柏长青. COVID-19患者康复早期临床特征、肺功能及影像学随访[J]. 解放军医学院学报, 2021, 42(4): 368-371, 406. DOI: 10.3969/j.issn.2095-5227.2021.04.002
ZHENG Jing, ZHAO Peng, LIU Huiying, HE Yuan, QIN Yanhong, YANG Ning, ZHANG Yue, WANG Haixia, BAI Changqin. Clinical characteristics, pulmonary function and chest CT features in the early follow-up to discharged patients with COVID-19[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(4): 368-371, 406. DOI: 10.3969/j.issn.2095-5227.2021.04.002
Citation: ZHENG Jing, ZHAO Peng, LIU Huiying, HE Yuan, QIN Yanhong, YANG Ning, ZHANG Yue, WANG Haixia, BAI Changqin. Clinical characteristics, pulmonary function and chest CT features in the early follow-up to discharged patients with COVID-19[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2021, 42(4): 368-371, 406. DOI: 10.3969/j.issn.2095-5227.2021.04.002

COVID-19患者康复早期临床特征、肺功能及影像学随访

Clinical characteristics, pulmonary function and chest CT features in the early follow-up to discharged patients with COVID-19

  • 摘要:
      背景  新型冠状病毒肺炎(COVID-19)自2019年12月始在世界范围内快速传播,对全世界产生巨大影响,其预后尚不十分清楚。
      目的  研究COVID-19患者康复早期临床特征、肺功能及肺部影像学情况。
      方法  随访2020年1月20日 - 4月2日在解放军总医院第五医学中心住院的COVID-19患者共38例,男性22例,女性16例,年龄20~78(50 ± 15)岁,重型和危重型患者为重症组(12例),轻型和普通型患者为轻症组(26例)。康复出院后1~3个月进行随访了解其症状、体征,影像学表现,测定肺功能。
      结果  随访患者中,9例轻微咳嗽,3例活动后胸闷,3例脱发,2例双手关节晨僵。部分患者存在肺功能异常,主要表现为轻度弥散功能障碍(7例,18.4%),其中6例属于重症组。9例(23.7%)存在小气道功能障碍。14例(36.8%)存在呼吸道症状的患者气道激发试验均为阳性。相关分析提示患者弥散功能与随诊CT累及肺叶数呈负相关(r=-0.387,P=0.024),与淋巴细胞计数呈正相关(r=0.399,P=0.021)。胸部高分辨率CT检查结果异常23例,以磨玻璃样改变为主,重型及危重型患者随访期间均未完全吸收。
      结论  COVID-19患者治愈出院后随访3个月内部分遗留有咳嗽、胸闷症状,部分患者存在肺功能损害和气道高反应性,重症患者存在肺弥散功能损害,胸部CT示部分病灶未完全吸收。

     

    Abstract:
      Background  Coronavirus disease 2019 (COVID-19) has been spreading rapidly worldwidely since December 2019, which has a great impact on the golbal health. However, the prognosis of COVID-19 remains unclear.
      Objective  To investigate the clinical characteristics, pulmonary functions and radiographic features of COVID-19 patients in the ealrly stage after discharge from hospital.
      Methods  A total of 38 COVID-19 patients admitted to the Fifth Medical Center of Chinese PLA General Hospital from January 20 to April 2 in 2020 were followed up. Of the 38 cases, there were 22 males and 16 females with average age of (50 ±15) years (range, 20 - 78 years). The cases were divided into the severe group (n=12) and the mild/moderate group (n=26). Their symptoms, signs, CT images and pulmonary function were analyzed.
      Results  During the follow-up, 9 patients had mild cough, 3 patients had chest tightness after exertion, 3 patients experienced hair loss, 2 patients had morning stiffness. Some patients had abnormal pulmonary functions, mainly manifested as mild diffusion dysfunction (7 cases, 18.4%), 6 cases of them were in the severe group. Nine patients (23.7%) had small airway dysfunction, 14 patients (36.8%) had positive results in bronchial challenge test. The diffusion function was negatively correlated with the number of lobes involved on CT (r=-0.387, P=0.024), while positively correlated with lymphocyte count (r=0.399, P=0.021). Abnormal chest HRCT results were found in 23 patients, with ground glass opacity as the main feature, while the lesion had not been completely absorbed in the severe and critically severe cases during the follow-up.
      Conclusion  After discharge, some COVID-19 patients had cough and chest tightness within 3 months, and abnormal lung function including airway hyperresponsiveness can be found. In severe cases, persisting lung pathologies on CT imaging exist.

     

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