探讨新型冠状病毒肺炎（COVID-19）高分辨率CT（HRCT）表现及胸部HRCT评分在COVID-19临床诊疗中的应用价值。

收集连云港地区同时行RT-PCR及胸部CT的COVID-19确诊患者28例及非COVID-19患者67例，观察分析病变的分布、范围、形态及密度，纵隔、肺门有无淋巴结，胸腔及胸膜有无异常。根据COVID-19的CT表现，利用胸部HRCT对COVID-19及非COVID-19患者进行评分并分为0~5级，分别评价各等级对COVID-19的诊断价值。

28例COVID-19中，胸部HRCT示病变呈双肺胸膜下或多中心分布20例，单发或多发斑片状或节段性磨玻璃密度影11例，磨玻璃伴小叶间隔增厚14例，磨玻璃伴实变8例，实变5例，支气管壁增厚或扩张18例，弥漫性小叶中心磨玻璃样结节分布5例，网格状及蜂窝样纤维索条5例，胸膜增厚1例。COVID-19与非COVID-19患者相比，病变呈双肺胸膜下或多中心分布（71% vs 12%）比例升高，磨玻璃伴小叶间隔增厚（50% vs 13%）比例升高，差异具有统计学意义（P＜0.001）。COVID-19与非COVID-19患者的其他HRCT表现，差异无统计学意义（P＞0.05）。以5级、4级及以上、3级及以上、2级及以上、1级及以上评分标准诊断COVID-19，敏感度、特异度、准确度、阳性预测值、阴性预测值、Kappa值分别为64.3%、97.0%、87.4%、90.0%、86.7%、0.669；92.9%、82.1%、85.3%、68.4%、96.5%、0.679；100.0%、59.7%、71.6%、50.9%、100.0%、0.466；100.0%、29.9%、50.5%、37.3%、100.0%、0.201；100.0%、7.5%、29.5%、31.1%、100.0%、0.045。

COVID-19胸部HRCT表现具有一定的特征。胸部HRCT评分可以对COVID-19高度疑似患者的控制及早期治疗提供有效的检查手段，有利于医疗机构控制疫情及提高治愈率。

To investigate the value of high-resolution computed tomography (HRCT) findings and chest HRCT scoring in the clinical diagnosis and treatment of coronavirus disease 2019 (COVID-19).

A total of 28 COVID-19 patients and 67 non-COVID-19 patients who underwent RT-PCR and chest CT simultaneously at Lianyungang were collected. The distribution, range, morphology, and density of lesions, mediastinal and hilar lymph nodes, and abnormalities in the thoracic cavity and pleura were observed and analyzed. According to the CT manifestations, chest HRCT was used to score COVID-19 and non-COVID-19 patients and divide them into grades 0 to 5, and the diagnostic value of each grade for COVID-19 was assessed.

Among the 28 cases of COVID-19, 20 presented subpleural or multicentric distribution of bilateral lung lesions as shown by chest HRCT, 11 had single or multiple patchy or segmental ground glass opacities (GGOs), 14 had GGOs accompanied by interlobular septal thickening, 8 had GGOs with consolidation, 5 had consolidation, 18 had bronchial wall thickening or dilatation, 5 had diffuse central ground glass nodules, 5 had mesh-or honeycomb-like fiber cords, and 1 had pleural thickening. Compared with non-COVID-19 patients, the incidence of bilateral subpleural or multicentre lesions (71% vs 12%, P＜0.001) and GGOs with septal thickening (50% vs 13%, P＜0.001) was significantly higher in COVID-19 patients, while other HRCT findings did not differ significantly between non-COVID-19 and COVID-19 patients. The sensitivities, specificities, accuracies, positive predictive values, negative predictive values, and Kappa values of HRCT grades 0-5 for the diagnosis of COVID-19 were 64.3%, 97.0%, 87.4%, 90.0%, 86.7%, 0.669, respectively.92.9%, 82.1%, 85.3%, 68.4%, 96.5%, and 0.679; 100.0%, 59.7%, 71.6%, 50.9%, 100.0%, and 0.466; 100.0%, 29.9%, 50.5%, 37.3%, 100.0%, and 0.201; and 100.0%, 7.5%, 29.5%, 31.1%, 100.0%, and 0.045, respectively.

COVID-19 has characteristic chest HRCT manifestations. Chest HRCT scoring can provide an effective means for the control and early treatment of highly suspected COVID-19 patients, which is beneficial to medical institutions to control the epidemic situation and improve the cure rate.