重症甲型H1N1流行性感冒肺炎高分辨率计算机X线断层扫描表现的动态变化

目的 探讨重症甲型H1N1流行性感冒(流感)肺炎高分辨率计算机X线断层扫描(HRCT)表现及动态变化.方法 回顾性分析36例临床确诊的重症甲型H1N1流感肺炎1个月内100次HRCT资料,分析其肺部病变出现、进展及吸收时间和影像学特点.结果 发病初期行HRCT检查(3d内)6例,小片磨玻璃密度影3例,小片实变影3例.病变进展期(发病3d后)36例患者均表现为双肺多发弥漫分布的磨玻璃密度影伴或不伴实变,其中主要呈弥漫磨玻璃密度影9例,占25.0％；弥漫磨玻璃密度影伴实变影20例,占55.6％;主要呈肺实变影7例,占19.4％；合并胸膜病变10例,占27.8％.在发病(8.0±2.6)d内病变进展最为明显,发病(16.0±4.8)d后为吸收期,36例病变均明显吸收,23例出现肺间质增生,占63.9％.病灶的动态变化分三型,包括先进展后吸收型、进展和吸收并存后吸收型和逐渐吸收型,以先进展后吸收型为主,占41.7％.结论 HRCT可准确显示重症甲型H1N1流感肺炎的病变形态和范围,监测其动态变化.

Appearances and dynamic changes of high resolution computed tomography in critical influenza A (H1N1) pneumonia

Objective To study the appearances and dynamic changes of chest high resolution computed tomography (HRCT) in clinically diagnosed critical influenza A (H1N1) pneumonia.Methods One hundred chest HRCT scanning examinations were performed in 36 cases of influenza A (H1N1) pneumonia who were diagnosed by the clinical manifestations in one month.The onset,progress and resolve of pulmonary manifestations were analyzed.Results Chest HRCT was performed in six patients,and small patchy opacity presented in three cases and ground-glass opacities presented in the other three cases within 3 days after onset when the disease was at the initial stage.Multiple larger opacities were visualized in all cases at the progressive stage (3 days later after onset),which included the pure ground-glass opacities (9 cases,25.0％ ),ground-glass opacities accompanied by consolidations (20 cases,55.6％),prominent consolidations (7 cases,19.4％),and accompanied pleural lesions (10,27.8％).The lesions strongly progressed within (8.0± 2.6) d and distinctly absorption in all cases (100.0％,36/36) within (16.0±4.8) d after onset of the disease.The pulmonary interstitial hyperplasia was found in 23 cases (63.9％).Dynamic change types of the lesions include absorption after progression,absorption and progression coexistence then absorption and gradually absorption,and absorption after progression was the major type (41.7％).Conclusion HRCT could distinctly demonstrate the shape,range and dynamic changes of pulmonary lesions of critical influenza A (H1 N1) pneumonia.