[新聞] 中國醫師發表33歲2019-nCoV病患肺部影像

[switch (pura vita!)]

發稿單位：Businessinsider
發稿時間：2020/02/01
撰 稿 者：Aria Bendix
原文連結：https://bit.ly/37N3Jc7

Radiology 論文連結: https://bit.ly/2UjkrvB

蘭州大學第一醫院的醫師在1/31於期刊 Radiology 發表一名33歲女性病患感染
新型冠狀病毒後的肺部影像。X光影像顯示患者肺部出現毛玻璃狀陰影。

患者在發病的前一天從武漢抵達蘭州，發燒到華氏102度 (攝氏38.9度)。

Thomas Jefferson University 的放射科醫師 Paras Lakhani 說如果不是因為
知道武漢爆發疫情，醫師可能會直接診斷為肺炎，肺炎在臨床上很常見。這樣的
陰影通常是表示肺部裡有液體。醫師很難單靠X光影想來判斷患者是否感染新型
冠狀病毒，因為細菌或其他病毒感染都可能引發肺炎。

但是研究人員注意到這些毛玻璃狀陰影延伸到患者的肺部邊緣。Lakhani 說這在
一般的肺炎上並不常見，但是我們在 SARS 或 MERS 上會看到這樣的情形。從這
名患者的X光影像看來，這些病毒有很多相似的特徵。

另外相隔三天後的第二張影像 (右側) 中毛玻璃狀陰影的面積明顯擴大，這有助
於將一般肺炎排除。Lakhani 說，通常一般肺炎不會進展的如此迅速。大多數醫
院通常會使用抗生素來治療，而病人多半在治療後病情會穩定下來並逐漸康復。

蘭州的醫師曾使用一種稱為干擾素的蛋白來治療這名病患。Lahkani 猜測他們可
能也使用了輸液、類固醇或插管等支持性療法。但病患的狀況仍持續惡化。

Lahkani 說這很重要，因為同樣的情形也曾發生在 SARS病患身上。

X光並非診斷新型關狀病毒最好的方式。採檢患者的唾液或是鼻腔或嘴巴黏膜或
是痰才是較好的方法。但是這樣的方法並不完美，通常只有患者出現症狀時，
才能檢測到病毒。



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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推 duriamon: 不錯喔！這蠻有意義的，只是不知道是不是所有病例都類似
→ duriamon: 這樣。如果是，那電腦斷層(CT)可能也能幫助病患分類。
推 hester90333: 沒意義，很多感染都長這樣
推 duriamon: 那就沒輒了…電腦斷層還是只能判斷有沒有感染跟肺炎症狀
→ duriamon: 。
推 Doralice: 電腦斷層無助於鑑別診斷啦...... 如果民眾一知半解吵著
→ Doralice: 要做反而會被防疫漏洞
→ Doralice: x光可以在隔離室照甚至戶外篩檢站就照，斷層無法也不是
→ Doralice: 負壓隔離
推 duriamon: 說得也是，還有其他病患要排隊照電腦斷層。
推 NewCop: 你今天要是確診還得靠電腦斷層那早就不知道傳給多少人了..
→ NewCop: .
推 NewCop: 這種東西或許在疫情結束幾年後在爆發時能讓醫生判斷，但現
→ NewCop: 在對於防疫幾乎是毫無價值
推 MoWilliams: 希望他不會被官方抓走
→ placo: 是不是可以當作一般肺炎跟武漢病毒肺炎的初始判斷