摘要目的 观察新型布尼亚病毒感染者肺部CT影像学特征,并分析其与临床指标变化的关系.方法 选取2011年5月至2012年8月浙江省舟山医院和岱山医院收治经浙江省疾病预防控制中心确诊并出现肺部影像学表现的19例新型布尼亚病毒感染者.所有患者在病程初期、极期及恢复期行肺部CT检查,动态观察患者白细胞(WBC)、血小板(PLT)、淋巴细胞(主要是CD4+T淋巴细胞)的变化,采用重复测量资料的方差分析及LSD对数据进行处理,并分析其值与肺部影像学之间的关系.结果 19例肺部影像学异常表现者中,磨玻璃影13例,结节影5例,网格状表现3例,胸膜增厚粘连5例,纵隔淋巴结肿大3例;其中16例为双侧肺部受累,3例为单侧受累;11例合并胸腔积液.15例出现明显肺部病变的患者WBC、PLT和CD4+T淋巴细胞在病程不同期间的数值差异具有统计学意义(F =20.21,28.37和32.92,P值均＜0.01),在病程极期数值最低,分别为(1.6±0.6)×109/L,(26.0±9.1)×109/L和(100.0 ±66.2)×106/L,经过适当治疗后,均恢复正常,且肺部CT均显示为病灶完全吸收,无后遗症.结论 新型布尼亚病毒感染者肺部CT表现与临床指标变化有一定关联,尽早治疗预后良好.

abstractsObjective To review pulmonary CT imaging features and their correlations with the changes on clinical indexes in patients infected with severe fever with thrombocytopenia syndrome bunyavirus (novel bunyavirus).Methods Clinical data and pulmonary CT findings of 19 patients infected with the novel bunyavirus in Zhoushan Hospital and Daishan Hospital of Zhejiang Province during May 2011 and August 2012 were collected.Infection of the novel bunyavirus was confirmed by Zhejiang Provincial Center for Disease Control and Prevention (CDC).All patients received high resolution CT scanning at initial period,critical period and recovery period.And the changes on WBC,platelet (PLT) and lymphocytes (mainly CD4 + T lymphocytes) were observed.Repeated measures analysis of variance and least significant difference (LSD) were performed,and correlation between the changes on clinical parameters and pulmonary imaging was studied.Results In pulmonary CT images,13 out of 19 cases presented groundglass shadow,5 cases presented consolidation shadow,3 cases presented retisculation,5 cases presented pleural thickening and adhesion,and 3 cases presented mediastinal lymphadenopathy.Sixteen patients presented the involvement of bilateral lungs and 3 patients unilateral.Pleural effusion was observed in 11 cases.There were significant differences in WBC,PLT and CD4+T count among initial,critical and recovery periods in 15 patients with obvious lung lesions (F =20.21,28.37 and 32.92,P ＜0.01).And the above indexes dropped to the lowest points during critical period,which were (1.6 ± 0.6) x 109/L,(26.0 ±9.1) x 109/L and (100.0 ± 66.2) x 106/L,respectively.After treatment,pulmonary CT scan showed that the foci were completely absorbed and no sequelae were observed.Conclusion The changes on pulmonary CT imaging are correlated with those of clinical indexes in novel bunyavirus infection,and the prognosis is good if patients receive the appropriate treatment in the early stage.