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目的探讨成人高致病性H5N1亚型禽流感病毒性重症肺炎的CT表现及动态变化。方法2006年6月所确诊的H5N1亚型禽流感病毒性重症肺炎成人男性患者于发病第7天、30天、40天、50天、65天及95天分别行螺旋CT及HRCT扫描。回顾性分析其CT资料并结合文献复习。结果病情严重时,CT显示肺叶或肺段大片状实变影伴支气管充气征、小淡片影及胸腔积液。病情稳定后,表现为多肺叶斑片状实变影、磨玻璃影,病灶内仍见支气管充气征。同时部分肺叶体积缩小,小叶间隔增厚、胸膜下细弧线影,相邻胸膜增厚。临床治愈出院以及近期复查时,大部分病灶消失,肺间质病灶吸收缓慢,以中叶、下叶为著。两肺散在多处条索状影,肺纹理聚集,胸膜下小叶间隔增厚,间隔旁小气肿,支气管扩张、扭曲。结论成人高致病性H5N1亚型禽流感病毒性重症肺炎的CT表现为早期肺叶实变影,逐渐发展肺实质与间质病变并存,恢复期则以肺间质病变为主。CT动态观察能较客观的反映本病的病理改变过程。
Objective To investigate the CT manifestations and dynamic changes of adult highly pathogenic H5N1 subtype avian influenza virus severe pneumonia. Methods The adult male H5N1 subtype of avian influenza virus pneumonia confirmed in June 2006 were scanned by spiral CT and HRCT respectively on the 7th, 30th, 40th, 50th, 65th and 95th days. Retrospective analysis of its CT data and literature review. Results When the condition was serious, CT showed large lobe of lung or lung segment consolidation with bronchial airway signs, small flecks and pleural effusion. Stable condition, manifested as multiple lobe patchy consolidation shadow, ground glass, lesions still see bronchial inflatable sign. At the same time part of the lung lobular volume reduction, interlobular septal thickening, subpleural arc curve, adjacent pleural thickening. Clinical cure and discharge and recent review, the majority of lesions disappear, interstitial lung lesions absorbed slowly, to the middle and lower leaves. Two lung scattered scattered in many cord-like shadow, lung texture gathered, subpleural interlobular septal thickening, next to the minor emphysema, bronchiectasis, distorted. Conclusion The CT manifestations of adult highly pathogenic H5N1 subtype of avian influenza virus severe pneumonia are early lobar consolidation. The progressive development of pulmonary parenchyma and interstitial disease coexist, and the recovery is mainly of interstitial lung disease. CT dynamic observation can objectively reflect the pathological changes of the disease process.