Значение инструментальных методов в диагностике пневмонии при коронавирусной инфекции

Войтенков В.Б., Марченко Н.В., Скрипченко Н.В. и др. Значение инструментальных методов в диагностике пневмонии при коронавирусной инфекции. Педиатрия. Consilium Medicum. 2020; 1: 20–25. DOI: 10.26442/26586630.2020.1.200120

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Voitenkov V.B., Marchenko N.V., Skripchenko N.V. et al. The value of instrumental methods in the diagnostics of pneumonia in coronavirus infection. Pediatrics. Consilium Medicum. 2020; 1: 20–25. DOI: 10.26442/26586630.2020.1.200120

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Аннотация

Приоритетным при инфекции, обусловленной коронавирусами, является своевременная диагностика таких ее проявлений, как вирусная пневмония. Наряду с оценкой клинического статуса значимым является применение таких инструментальных методов визуализации, как компьютерная томография (КТ) и рентгенография легких. В оценке легочной паренхимы при вирусных пневмониях, в том числе и вызванных COVID-19, рентгенография малоинформативна. Авторы предлагают тактику ранней инструментальной диагностики поражений легких и их функционального состояния при коронавирусной инфекции. Большей диагностической ценностью при вирусных интерстициальных пневмониях обладает КТ, которую авторы предлагают проводить в первую очередь. В условиях массового поступления пациентов и загруженности КТ предлагается проведение ультразвукового исследования легких как методики динамического наблюдения и скрининга с учетом свойственных ей ограничений. При необходимости объективизации функции легких целесообразно проводить спирометрию согласно установленным стандартам. Авторы отмечают, что для двусторонней интерстициальной вирусной пневмонии характерен рестриктивный паттерн изменений. В случае его выявления оцениваются также диффузионная способность и общая емкость легких.

Ключевые слова: коронавирусная инфекция, COVID-19, инструментальная диагностика, компьютерная томография, спирометрия.

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Main goal in the managing of the coronavirus infections is the timely diagnosis of the viral pneumonia. Along with the key clinical signs main instrumental methods are computed tomography (CT) and lungs X-ray. However, in the lungs tissues evaluation in viral pneumonias, including ones associated with a COVID-19, X-ray are not very informative. We propose the tactic of the early instrumental diagnostic of lung`s degree of lesion and functional state in coronavirus infection. As the lung CT is more informative in the evaluation of the state of the lungs, it has to be done in the first place. In case of general lack of resources and high demand for CT, lung ultrasound may be performed as a secondary measure. Limitations and low specificity of lung ultrasound should be considered in evaluation of its results. If some need arise to evaluate the functional state of the lungs, we propose the spirometry. Bilateral interstitial pneumonia would be suspected if restrictive pattern is registered. In that case diffusion capacity and total lung capacity are evaluated as well.

Key words: coronavirus infection, COVID-19, instrumental diagnostics, computed tomography, spirometry.

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1. Ruuskanen O, Lahti E, Jennings LC et al. Viral pneumonia. Lancet 2011; 377 (9773): 1264–75. DOI: 10.1016/S0140-6736(10)61459-6
2. Galván JM, Rajas O, Aspa J. Review of Non-Bacterial Infections in Respiratory Medicine: Viral Pneumonia. Arch Bronconeumol 2015; 51 (11): 590–7. DOI: 10.1016/j.arbres.2015.02.015
3. Gorenchuk A.N., Kulikov P.V., Zhogolev S.D. et al. Etiologicheskaia kharakteristika ostrykh boleznei organov dykhaniia u voennosluzhashchikh zapadnogo voennogo okruga v 2014–2019 gg. Vestn. Ros. voenno-meditsinskoi akademii. 2020; 1 (69): 81–6 (in Russian).
4. Sorensen MD, Sorensen B, Gonzalez-Dosal R et al. Severe acute respiratory syndrome (SARS): development of diagnostics and antivirals. Ann New York Acad Sci 2006; 1067 (1): 500. DOI: 10.1196/annals.1354.072
5. Distribution of confirmed cases of MERS-CoV by place of infection and month of onset, from March 2012 to 2 December 2019. Available at: https://www.ecdc.europa.eu/en/publications-data/distribution-confirmed-cases-mers-cov-place-infectio...
6. Novel Coronavirus (2019-nCoV). Situation Report – 8. World Health Organization. https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200128-sitrep-8-ncov-cleare...
7. Yu F, Du L, Ojcius DM et al. Measures for diagnosing and treating infections by a novel coronavirus responsible for a pneumonia outbreak originating in Wuhan, China. Microbes Infect 2020; 22 (2): 74–9. DOI: 10.1016/j.micinf.2020.01.003
8. Song Z, Xu Y, Bao L et al. From SARS to MERS, Thrusting Coronaviruses into the Spotlight. Viruses 2019; 11 (1): 59. DOI: 10.3390/v11010059
9. Lu R, Zhao X, Li J et al. Genomic characterization and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020; 395 (10224): 565–74. DOI: 10.1016/S0140-6736 (20)30251-8
10. Wan Y, Shang J, Graham R et al. Receptor recognition by novel coronavirus from Wuhan: An analysis based on decade-long structural studies of SARS. J Virol 2020; 94 (7): e00127–20.
11. Yuan Y, Cao D, Zhang Y et al. Cryo-EM structures of MERS-CoV and SARS-CoV spike glycoproteins reveal the dynamic receptor binding domains. Nat Commun 2017; 8: 15092.
12. Hulswit RJ, de Haan CA, Bosch BJ. Coronavirus Spike Protein and Tropism Changes. Adv Virus Res 2016; 96: 29–57.
13. Khan S, Ali A, Siddique R, Nabi G. Novel coronavirus is putting the whole world on alert. J Hosp Infect 2020; 104 (3): 252–3.
14. Huang C, Wang Y, Li X, Ren L. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
15. Chen N, Zhou M, Dong X, Qu J. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507–13.
16. Nikiforov V.V., Suranova T.G., Mironov A.Iu., Zabozlaev F.G. New coronavirus infection (COVID-19): etiology, epidemiology, clinic, diagnosis, treatment and prevention. Teaching aid. Moscow: Akademiia postdiplomnogo obrazovaniia FGBU "FNKTs FMBA Rossii", 2020 (in Russian).
17. Huang C, Wang Y, Li X, Ren L. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; 395: 497–506.
18. Chen N, Zhou M, Dong X, Qu J. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet 2020; 395 (10223): 507–13.
19. Li YC, Bai WZ, Hashikawa T. The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol 2020; DOI: 10.1002/jmv.25728
20. ARTP COVID19 Update – 18th March 2020.
21. Chuchalin A.G., Aisanov Z.R., Chikina S.Iu. et al. Federal'nye klinicheskie rekomendatsii Rossiyskogo respiratornogo obshchestva po ispol'zovaniiu metoda spirometrii. Pul'monologiia. 2014; 6: 11–24. DOI: 10.18093/0869-0189-2014-0-6-11-24 (in Russian).
22. Miller MR, Hankinson J, Brusasco V et al. Standardization of spirometry. Eur Respir J 2005; 26: 319–38.
23. New coronavirus infection (COVID-19): etiology, epidemiology, clinic, diagnosis, treatment and prevention. Teaching aid №21. Moscow, 2020 (in Russian).
24. Ai T, Yang Z, Hou H et al. Correlation of Chest CT and RT-PCR Testing in Coronavirus Disease 2019 (COVID-19) in China: A Report of 1014 Cases. Radiology 2020; p. 200642. DOI: 10.1148/radiol.2020200642
25. Knipe H, Bell DJ et al. COVID-19. https: //radiopaedia.org/articles/covid-19-3
26. Handbook of COVID-19 Prevention and Treatment. Ed. by T.Liang. Zhejiang University School of Medicine, 2020.
27. Morozov S.P., Protsenko D.N., Smetanina S.V. et al. Radiation diagnosis of coronovirus disease (COVID-19): organization, methodology, interpretation of results. Series: Best Practices in Radiation and Instrumental Diagnostics. Vyp. 65. Moscow: GBUZ NPKTs DiT DZM, 2020 (in Russian).
28. Buonsenso D, Piano A, Raffaelli F et al. Point-of-Care Lung Ultrasound findings in novel coronavirus disease-19 pnemoniae: a case report and potential applications during COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24 (5): 2776–80. DOI: 10.26355/eurrev_202003_20549
29. Soldati G, Smargiassi A, Inchingolo R et al. Is there a role for lung ultrasound during the COVID-19 pandemic? J Ultrasound Med 2020. DOI: 10.1002/jum.15284
30. Lung Ultra Sound and COVID-19 Pandemic. http: //sonomir.wordpress.com/
31. Vlasenko A.V. Acute Respiratory Distress Syndrome – What's New in 2020?
https: //mosgorzdrav.ru/uploads/imperavi/ru-RU/present_30032020_vlasenko.pdf (in Russian).

Авторы

В.Б. Войтенков*, Н.В. Марченко, Н.В. Скрипченко, М.Г. Капитон, М.А. Бедова

ФГБУ «Детский научно-клинический центр инфекционных болезней» ФМБА России, Санкт-Петербург, Россия
*vlad203@inbox.ru

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Vladislav B. Voitenkov*, Natalya V. Marchenko, Natalya V. Skripchenko, Marina G. Kapiton, Mariia A. Bedova

Pediatric Research and Clinical Center for Infectious Diseases, Saint Petersburg, Russia
*vlad203@inbox.ru

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