剪切波弹性成像在慢性阻塞性肺疾病患者股四头肌病变评估中的应用研究

Application value of shear wave elastography in evaluating the quadriceps femoris lesions in patients with chronic obstructive pulmonary disease

目的探究超声剪切波弹性成像(shear wave elastography,SWE)在慢性阻塞性肺疾病(简称慢阻肺)患者股四头肌病变评估中的临床价值。方法纳入成都市第一人民医院2021年8月一2022年2月收治的慢阻肺患者58例和同期健康对照组55例。采用SWE联合常规二维超声测量受试者股四头肌厚度、周长、横截面积及杨氏模量,比较两组间超声参数的差异,分析各超声参数与临床评价指标(改良版英国医学研究委员会呼吸困难量表、慢阻肺评估测试、六分钟步行试验、五次坐立试验)之间的相关性。结果慢阻肺组股四头肌杨氏模量值小于健康对照组[慢阻肺组:股直肌6.72(6.22,7.36)kPa,股内侧肌6.25(5.82,6.79)kPa,股外侧肌6.94(6.17,7.48)kPa;健康对照组:股直肌11.40(10.23,12.11)kPa,股内侧肌10.77(9.62,11.42)kPa,股外侧肌11.14(10.42,12.52)kPa],差异均有统计学意义(均P<0.05)。其中,股直肌杨氏模量值与六分钟步行距离呈正相关,与慢阻肺疾病评估测试评分、改良英国医学研究委员会呼吸困难量表评分、五次坐立试验时间呈负相关(均P<0.05)。常规二维超声测量的股四头肌厚度、周长、横截面积在两组间差异无统计学意义,各参数与临床评价指标间也无显著相关性(均P>0.05)。SWE在股四头肌杨氏模量测量方面具有较好的可重复性。结论SWE可较常规二维超声更早地识别慢阻肺患者股四头肌病变,且其测量指标与慢阻肺患者的临床病情存在显著相关性。超声SWE技术或可为临床评价慢阻肺患者股四头肌病变提供一种简便、无创的方法。

Objective To explore the clinical value of shear wave elastography in the evaluation of quadriceps femoris lesions in patients with chronic obstructive pulmonary disease(COPD).Methods Fifty-eight COPD patients who were admitted to Chengdu First People’s Hospital and 55 healthy controls were included in the study between August 2021 and February 2022.The thickness,circumference,cross-sectional area and Young’s modulus of quadriceps femoris in all subjects were measured using shear wave elastography combined with conventional twodimensional ultrasound.The differences in ultrasound parameters between the two groups were compared,and the correlation between each ultrasound parameter and clinical evaluation indicators(modified British Medical Research Council Scale,COPD Assessment Test,six-minute walk test,and five-time sit-to-stand test)was analyzed.Results Young’s modulus values of the quadriceps femoris muscle were smaller in the COPD group than those in the healthy control group[COPD Group:rectus femoris 6.72(6.22,7.36)kPa,vastus medialis 6.25(5.82,6.79)kPa,vastus lateralis 6.94(6.17,7.48)kPa;healthy control group:rectus femoris 11.40(10.23,12.11)kPa,vastus medialis 10.77(9.62,11.42)kPa,vastus lateralis 11.14(10.42,12.52)kPa].The differences were statistically significant(all P<0.05).The Young’s modulus value of the rectus femoris muscle correlates with the aforementioned clinical evaluation indicators,with positive correlation with six-minute walk distance and negative correlation with COPD Assessment Test,modified British Medical Research Council Scale,five-time sit-to-stand time(P<0.05).Quadriceps thickness,circumference,and cross-sectional are a measured by conventional two-dimensional ultrasound were not significantly different between the two groups,nor were there significant correlations between each parameter and clinical parameters(P>0.05).In addition,shear wave elastography has good reproducibility in the measurement of Young’s modulus in quadriceps.Conclusions Shear wave elastography can identify quadriceps lesions earlier than conventional two-dimensional ultrasound in COPD patients,and there is a significant correlation between its measurements and the clinical condition of COPD patients.Shear wave elastography may provide a simple and noninvasive method for clinical evaluation of quadriceps femoris lesions in COPD patients.