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[Chest最新论文]: 仅见于CT扫描而非胸片的社区获得性肺炎:病原学、严重程度及临床预后
2018年05月03日 时讯速递, 进展交流 暂无评论

Community-Acquired Pneumonia Visualized on CT Scans but Not Chest Radiographs: Pathogens, Severity, and Clinical Outcomes

Cameron P. Upchurch, Carlos G. Grijalva, Richard G. Wunderink, et al.

CHEST 2018; 153(3):601-610

BACKGROUND: 背景

The clinical significance of pneumonia visualized on CT scan in the setting of a normal chest radiograph is uncertain.

当胸片正常时,CT扫描可见的肺炎其临床意义并不明确。

METHODS: 方法

In a multicenter prospective surveillance study of adults hospitalized with community-acquired pneumonia (CAP), we compared the presenting clinical features, pathogens present, and outcomes of patients with pneumonia visualized on a CT scan but not on a concurrent chest radiograph (CT-only pneumonia) and those with pneumonia visualized on a chest radiograph. All patients underwent chest radiography; the decision to obtain CT imaging was determined by the treating clinicians. Chest radiographs and CT images were interpreted by study-dedicated thoracic radiologists blinded to the clinical data.

在这项有关因社区获得性肺炎(CAP)住院的成年患者的多中心、前瞻调查研究中,我们将仅见于CT而非胸片的肺炎患者(CT肺炎)与胸片可见肺炎患者进行了比较,对比两组患者的临床特征、病原微生物和临床预后。胸片及CT影像均由不了解临床资料的指定的放射科医生判读。

RESULTS: 结果

The study population included 2,251 adults with CAP; 2,185 patients (97%) had pneumonia visualized on chest radiography, whereas 66 patients (3%) had pneumonia visualized on CT scan but not on concurrent chest radiography. Overall, these patients with CT-only pneumonia had a clinical profile similar to those with pneumonia visualized on chest radiography, including comorbidities, vital signs, hospital length of stay, prevalence of viral (30% vs 26%) and bacterial (12% vs 14%) pathogens, ICU admission (23% vs 21%), use of mechanical ventilation (6% vs 5%), septic shock (5% vs 4%), and inhospital mortality (0 vs 2%).

研究入选2251名成年CAP患者;2185名(97%)患者胸片可见肺炎,其余66名(3%)患者仅在CT扫描而非胸片可见肺炎。总体上看,CT肺炎组患者的临床表现与胸片肺炎患者相似,包括基础疾病、生命体征、住院日、病毒(30% vs 26%)和细菌(12% vs 14%)的比例,以及入住ICU(23% vs 21%)、机械通气(6% vs 5%)、感染性休克 (5% vs 4%) 及住院病死率(0 vs 2%)。

CONCLUSIONS: 结论

Adults hospitalized with CAP who had radiological evidence of pneumonia on CT scan but not on concurrent chest radiograph had pathogens, disease severity, and outcomes similar to patients who had signs of pneumonia on chest radiography. These findings support using the same management principles for patients with CT-only pneumonia and those with pneumonia seen on chest radiography.

因CAP住院的成年患者中,仅在CT扫描而非同期胸片可见肺炎患者,其病原微生物、疾病严重程度及临床预后与胸片可见肺炎表现患者相似。这些发现支持对仅在CT扫描可见肺炎患者采用与胸片可见肺炎患者相同的治疗策略。

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