恶性肿瘤合并不同SARS-CoV-2毒株感染患者的临床特征及影像学差异[ 基金项目：浙江省教育厅抗疫专项（Y202043691）]

目的 分析并比较恶性肿瘤患者合并不同新型冠状病毒（severe acute respiratory syndrome coronavirus 2，SARS-CoV-2）感染后影像学差异，为临床提供更加准确的参考和指导。方法 搜集2020年2月10日至3月30日于华中科技大学同济医学院附属同济医院光谷院区确诊为COVID-19合并恶性肿瘤的患者纳入原始株组，并搜集2022年6月1日至11月1日于杭州市新型冠状病毒肺炎救治定点医院确诊为COVID-19合并恶性肿瘤的患者纳入变异株组，对两组纳入患者进行回顾性分析。比较两组纳入患者胸部CT（Computed Tomography，CT）影像学及临床症状差异。结果 原始株组和变异株组发热比例分别是77.8%和54.5%；两组患者呼吸道症状主要是咳嗽咳痰（70.4% vs 48.5%），鼻塞流涕（30.0% vs 57.6%），胸闷（22.2% vs 39.3%），胸痛（3.7% vs 6.1%）；两组患者消化道症状主要为腹泻（7.4% vs 3.0%），全身症状主要为乏力（11.1% vs 6.1%）。胸部 CT 基本征象分析结果显示原始株组和变异株组累及双肺比例分别为88.9%和63.6%；两组患者基本征象为斑片影或磨玻璃影（74.1% vs 78.8%），部分实变（18.5% vs 9.1%），结节（33.3% vs 15.2%），反应性胸膜增厚（40.7% vs 36.4%,），胸腔积液（25.9% vs 3.0%），肺气肿（11.1% vs 6.7%），细支气管扩张征（25.9% vs 3.0%），肺不张（11.1% vs 3.0%），淋巴结增大（7.4% vs 15.2%），肺空洞（7.4% vs 3.0%）。结论 两组患者临床症状及影像学表现复杂多样，原始株病毒感染肺部影像学提示病灶主要常表现为双肺分布，细支气管扩张征、胸腔积液。

Clinical and Imaging Manifestations Differences in Patients with Malignant Tumors Infected by SARS-CoV-2

Abstract: Objective:To assess and compare clinical and imaging manifestations differences of patients diagnosed with malignant tumors who are concurrently infected with distinct strains of SARS-CoV-2. Methods:Patients confirmed COVID-19 with malignant tumors were retrospectively analyzed in two groups. The patients from Tongji Hospital affiliated to Tongji Medical College, Huazhong University of Science and Technology between February 10, 2020 and March 30, 2020 were included in the original strain group, and the patients from the Appointed Medical Institutions of COVID-19 in Hangzhou between June 1, 2022 and November 1, 2022 in the variant strain group. Chest computed tomography (CT) images and clinical symptoms were compared between the two groups. Results:The fever incidence rates were 77.8% and 54.5% in the original strain group and the variant strain group, respectively. The respiratory symptoms in both groups were mainly cough and sputum (70.4% vs 48.5%), nasal congestion and discharge (30.0% vs 57.6%), chest tightness (22.2% vs 39.3%), and pain (3.7% vs 6.1%). The digestive symptoms in both groups were mainly diarrhea (7.4% vs 3.0%), while the systemic symptoms were mainly fatigue (11.1% vs 6.1%). The basic CT signs analysis showed that the proportion of bilateral lung involvement in the original strain group and the variant strain group were respectively 88.9% and 63.6%. The basic characteristics of the two groups of patients were patchy shadows or focal ground-glass opacities (74.1% vs 78.8%), partial consolidation (18.5% vs 9.1%), nodules (33.3% vs 15.2%), reactive pleural thickening (40.7% vs 36.4%), pleural effusion (25.9% vs 3.0%), emphysema (11.1% vs 6.7%), bronchiectasis (25.9% vs 3.0%), atelectasis (11.1% vs 3.0%), lymph node enlargement (7.4% vs 15.2%), and pulmonary cavities (7.4% vs 3.0%). Conclusion:The clinical and lung CT imaging manifestations of patients in both groups were complex and diverse. The lung CT imaging manifestations of people infected with original strains of COVID-19 are primarily characterized by bilateral distribution of lesions, accompanied by features such as bronchial wall thickening and pleural effusion.