彭敏;孙雪峰;赵静;王京岚;宋兰;王孟昭;施举红;李太生;张奉春;蔡柏蔷;朱元珏;
PENG Min;SUN Xue-feng;ZHAO Jing;WANG Jing-lan;SONG Lan;WANG Meng-zhao;SHI Ju-hong;LI Tai-sheng;ZHANG Feng-chun;CAI Bai-qiang;ZHU Yuan-jue;Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Infectious diseasesPeking Union Medical College Hospital,Chine

• 1:中国医学科学院北京协和医学院北京协和医院呼吸与危重症医学科
• 2:中国医学科学院北京协和医学院北京协和医院放射科
• 3:中国医学科学院北京协和医学院北京协和医院感染内科
• 4:中国医学科学院北京协和医学院北京协和医院风湿免疫科

摘要(Abstract)：

2019年12月以来,我国陆续出现新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)病例,主要表现为发热、干咳、呼吸困难、外周血白细胞不高、淋巴细胞降低以及肺内阴影。国家卫健委在短期内连续7次修订诊疗方案,足以说明该病诊疗难度之大。部分COVID-19患者影像学表现为双肺弥漫性间质改变,与临床中所见的某些间质性肺炎相似。在当前全球COVID-19疫情形势仍极为严峻的情况下,需与某些急性或急进性间质性肺炎进行鉴别诊断,既要防止漏诊,又要防止因误诊而贻误原发病的治疗。本文将COVID-19与北京协和医院历年收治的多种间质性肺炎进行比较,提出了鉴别诊断思路。
Coronavirus disease 2019(COVID-19) emerged in China in late 2019, which was manifested as fever, cough, dyspnea, normal level of white blood cells, decreased blood lymphocytes, and pulmonary opacities on CT scans. National Health Commission of the People's Republic of China has revised the recommendations on COVID-19 seven times, but there are still many challenges in the diagnosis and management of COVID-19. The radiological findings in a proportion of patients revealed diffuse interstitial opacities, mimicking interstitial pneumonia. Thus it is essential to differentiate the COVID-19 from the acute and progressive diffuse interstitial lung diseases in order to avoid misdiagnosis or overdiagnosis. Therefore, our study compared COVID-19 with interstitial pneumonia and tried to explore the differential diagnostic algorithm.

关键词(KeyWords)： 新型冠状病毒肺炎;间质性肺炎;鉴别诊断
coronavirus disease 2019;interstitial pneumonias;differential diagnosis

Abstract:

Keywords:

基金项目(Foundation):

作者(Authors): 彭敏;孙雪峰;赵静;王京岚;宋兰;王孟昭;施举红;李太生;张奉春;蔡柏蔷;朱元珏;
PENG Min;SUN Xue-feng;ZHAO Jing;WANG Jing-lan;SONG Lan;WANG Meng-zhao;SHI Ju-hong;LI Tai-sheng;ZHANG Feng-chun;CAI Bai-qiang;ZHU Yuan-jue;Department of Pulmonary and Critical Care Medicine, Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Radiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Infectious diseasesPeking Union Medical College Hospital,Chine

参考文献(References)：

• [1] Huang C,Wang Y,Li X,et al.Clinical features of patients infected with 2019 novel coronavirus in Wuhan,China[J].Lancet,2020,395:497- 506.
• [2] Wang D,Hu B,Hu C,et al.Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan,China[J].JAMA,2020,323:1061- 1069.
• [3] Chen N,Zhou M,Dong X,et al.Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan,China:a descriptive study[J].Lancet,2020,395:507- 513.
• [4] Li Q,Guan X,Wu P,et al.Early Transmission Dynamics in Wuhan,China,of Novel Coronavirus-Infected Pneumonia[J].N Engl J Med,2020,382:1199- 1207.
• [5] 李妍,徐胜勇,杜铁宽,等.2019新型冠状病毒肺炎临床特点及筛查流程探讨[J].中华急诊医学杂志,2020,29:320- 324.
• [6] Guan WJ,Ni ZY,Hu Y,et al.Clinical Characteristics of Coronavirus Disease 2019 in China[J].N Engl J Med,2020,382:1708- 1720.
• [7] 国家健康卫生委办公厅,国家中医药管理局办公室.新型冠状病毒肺炎诊疗方案(试行第七版)[S].国卫办医函[2020]184号.
• [8] 北京协和医院新型冠状病毒感染的肺炎诊治专家组.北京协和医院关于“新型冠状病毒感染的肺炎”诊疗建议方案(V2.0)[J].协和医学杂志,2020.doi:10.3969/j.issn.1674- 9081.20200022.
• [9] Xie XZ,Zhong Z,Zhao W,et al.Chest CT for Typical 2019-nCoV Pneumonia:Relationship to Negative RT-PCR Testing[J].Radiology,2020,296:E41-E45.
• [10] 黄璐,韩瑞,于朋鑫,等.新型冠状病毒肺炎不同临床分型间CT和临床表现的相关性研究[J].中华放射学杂志,2020,54:300- 304.
• [11] Chung M,Bernheim A.CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV)[J].Radiology,2020,295:202- 207.
• [12] 中华医学会放射学分会.新型冠状病毒感染的肺炎的放射学诊断:中华医学会放射学分会专家推荐意见第一版[J].中华放射学杂志,2020,54:279- 285.
• [13] Tian S,Hu W,Niu L,et al.Pulmonary Pathology of Early-Phase 2019 Novel Coronavirus (COVID- 19) Pneumonia in Two Patients With Lung Cancer[J].J Thorac Oncol,2020,15:700- 704.
• [14] Xu Z,Shi L,Wang Y,et al.Pathological findings of COVID- 19 associated with acute respiratory distress syn-drome[J].Lancet Respir Med,2020,8:420- 422.
• [15] Luo W,Yu H,Gou J,et al.Clinical pathology of critical patient with novel coronavirus pneumonia (COVID-19)[J].Preprints,2020.doi:10.13140/RG.2.2.22934.29762.
• [16] Bradley BT,Bryan A.Emerging respiratory infections:The infectious disease pathology of SARS,MERS,pandemic influenza,and Legionella[J].Semin Diagn Pathol,2019,36:152- 159.
• [17] Guarner J.Three Emerging Coronaviruses in Two Decades[J].Am J Clin Pathol,2020,153:420- 421.
• [18] Travis WD,Costabel U,Hansell DM,et al.An official American Thoracic Society/European Respiratory Society statement:Update of the international multidisciplinary classification of the idiopathic interstitial pneumonias[J].Am J Respir Crit Care Med,2013,188:733- 748.
• [19] 施举红,许文兵,刘鸿瑞,等.多发性肌炎/皮肌炎合并肺间质性病变的临床特征[J].中华结核和呼吸杂志,2008,31:250- 254.
• [20] 施举红,许文兵,刘鸿瑞,等.隐源性机化性肺炎18例的临床病理特征[J].中华结核和呼吸杂志,2006,29:167- 170.
• [21] 施举红,严晓伟,许文兵,等.药物性肺损伤的临床诊断与治疗[J].中华结核和呼吸杂志,2007,30:161- 166.
• [22] Azadeh N,Limper AH,Carmona EM,et al.The Role of Infection in Interstitial Lung Diseases:A Review[J].Chest,2017,152:842- 852.
• [23] He H,Wang H,Li X,et al.Successful management of refractory respiratory failure caused by avian influenza H7N9 and secondary organizing pneumonia:a case report and literature review[J].BMC Infect Dis,2019,19:671.
• [24] Asai N,Yokoi T,Nishiyama N,et al.Secondary organizing pneumonia following viral pneumonia caused by severe influenza B:a case report and literature reviews[J].BMC Infect Dis,2017,17:572.
• [25] Liu H,Li J,Chen M,et al.Glucocorticoid treatment of suspected organizing pneumonia after H7N9 infection:A case report[J].Medicine (Baltimore),2019,98:e16839.
• [26] Ishiguro T,Kobayashi Y,Uozumi R,et al.Viral Pneumonia Requiring Differentiation from Acute and Progressive Diffuse Interstitial Lung Diseases[J].Intern Med,2019,58:3509- 3519.