发稿单位：Businessinsider 发稿时间：2020/02/01 撰 稿 者：Aria Bendix 原文连结：https://bit.ly/37N3Jc7 Radiology 论文连结: https://bit.ly/2UjkrvB 兰州大学第一医院的医师在1/31於期刊 Radiology 发表一名33岁女性病患感染 新型冠状病毒後的肺部影像。X光影像显示患者肺部出现毛玻璃状阴影。 患者在发病的前一天从武汉抵达兰州，发烧到华氏102度 (摄氏38.9度)。 Thomas Jefferson University 的放射科医师 Paras Lakhani 说如果不是因为 知道武汉爆发疫情，医师可能会直接诊断为肺炎，肺炎在临床上很常见。这样的 阴影通常是表示肺部里有液体。医师很难单靠X光影想来判断患者是否感染新型 冠状病毒，因为细菌或其他病毒感染都可能引发肺炎。 但是研究人员注意到这些毛玻璃状阴影延伸到患者的肺部边缘。Lakhani 说这在 一般的肺炎上并不常见，但是我们在 SARS 或 MERS 上会看到这样的情形。从这 名患者的X光影像看来，这些病毒有很多相似的特徵。 另外相隔三天後的第二张影像 (右侧) 中毛玻璃状阴影的面积明显扩大，这有助 於将一般肺炎排除。Lakhani 说，通常一般肺炎不会进展的如此迅速。大多数医 院通常会使用抗生素来治疗，而病人多半在治疗後病情会稳定下来并逐渐康复。 兰州的医师曾使用一种称为干扰素的蛋白来治疗这名病患。Lahkani 猜测他们可 能也使用了输液、类固醇或插管等支持性疗法。但病患的状况仍持续恶化。 Lahkani 说这很重要，因为同样的情形也曾发生在 SARS病患身上。 X光并非诊断新型关状病毒最好的方式。采检患者的唾液或是鼻腔或嘴巴黏膜或 是痰才是较好的方法。但是这样的方法并不完美，通常只有患者出现症状时， 才能检测到病毒。 In a study released in the journal Radiology on Friday, a group of researchers at The First Hospital of Lanzhou University presented two of the woman's chest X-rays side by side. The scans show white patches in the lower corner of her lungs, which indicate what radiologists call "ground glass opacity." "If you zoom in on the image, it kind of looks like faint glass that has been ground up," Paras Lakhani, a radiologist at Thomas Jefferson University who was not involved in the study but examined the images, told Business Insider. "What it represents is fluid in the lung spaces." https://i.imgur.com/jW9Tut2.jpg The X-rays provide researchers a few new clues about the nature of the virus. The scans show the new coronavirus looks similar to SARS and MERS Coronaviruses are a large group of viruses that typically affect the respiratory tract. They also cause pneumonia and the common cold. Symptoms of the new coronavirus include a fever, chills, headaches, difficulty breathing, and a sore throat. Until December, it had never been seen in humans. The novel coronavirus was first identified among a small group of people exhibiting pneumonia-like symptoms in Wuhan, China, in December. The 33-year-old patient whose lungs are shown in the new x-rays works in Wuhan, but had traveled to Lanzhou a day before her symptoms started. "If you didn't know about this outbreak, you'd read the scan and you would just say, 'Okay, this patient has pneumonia,' because that's the most common thing we see," Lakhani said. On its own, he added, ground glass isn't particularly helpful for identifying a coronavirus. "You can see it with all types of infections — bacterial, viral, or sometimes even non-infectious causes," Lakhani said. "Even vaping could sometimes appear this way." But the researchers also noticed that the ground-glass patches extend to the edges of the patient's lungs. "That's something we don't often see," Lakhani said. "We saw that with severe acute respiratory syndrome (SARS) and we saw that with Middle East respiratory syndrome (MERS)." Lakhani said scans of those viruses have "a lot of similar features" to the images from the 33-year-old patient. The scans show the virus getting worse after 3 days The researchers also saw that the white patches on the woman's lungs were more pronounced in the second image, taken three days after the first — and further into her treatment. That helps rule out the possibility of pneumonia. "Pneumonia usually doesn't rapidly progress," Lakhani said. "Typically, most hospitals will treat with antibiotics and patients will stabilize and then start to get better." In the hospital, the 33-year-old woman in Lanzhou inhaled a protein used to treat viral infections, called interferon. Lakhani guessed that doctors probably also administered "supportive treatment," such as fluids, steroids, or a medication to open the woman's airways. But she continued to get worse. That's significant, Lakhani said, since the same thing occurred in SARS patients. The best way to diagnose the coronavirus isn't via X-rays, though — it's a laboratory test, which involves taking swabs of saliva or mucus from a patient's nose and mouth or testing phlegm they may cough up. But the test isn't perfect, since it can only detect the virus when a person is showing symptoms. --

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