COPD患者膈肌厚度与肺功能的相关性研究

The correlation research between the Diaphragm Thickness and the Pulmonary Function in COPD patients

目的观察慢性阻塞性肺疾病(COPD)患者膈肌厚度及其变化,评价其与肺功能的关系。方法选取呼吸内科门诊COPD患者为COPD组80例,对照组60例,分别行肺功能检查、FRC和TLC时相测量膈肌厚度,计算从FRC至TLC时相膈肌厚度的变化。结果 COPD患者膈肌厚度较对照组显著下降[FRC:(0.18±0.04)cm和(0.20±0.04)cm,t=3.071,P<0.05;TLC:(0.41±0.14)cm和(0.50±0.09)cm,t=4.701,P<0.05]。厚度分数较降低(1.19±0.28和1.50±0.26,t=6.479,P<0.05)。COPD患者TLC时相的膈肌厚度和厚度分数与气道阻塞(FEV1.0,P<0.05)呈高度正相关性,与肺气肿和最大自主通气能力(TLC、MVV,P<0.05)呈中度相关性。COPD膈肌厚度及其变化在中度以上气流受限变化明显(>13.3%)。结论超声可以实时动态非侵入性的观察膈肌空间变量,并能够进行直接、准确、客观地量化评价具有潜在的临床应用价值。

Objective To assess alterations of diaphragm thickness in patients with COPD and to evaluate the influence of alterations of diaphragm thickness on pulmonary function in COPD patients. Methods 80 COPD patients were recruited from the respira- tory outpatient of Shanghai East Hospital of Tongji University and 60 control subjects were included. All subjects were performed with the pulmonary function and ultrasound measurement of diaphragm thickness. The diaphragm thickening fraction was calculated by diaphragm thickness from FRC to TLC. Results The COPD patients presented with lower diaphragm thickness and thickening fraction （TF） com- pared with the control subjects （ TD, FRC ：0.18 ± 0.04 vs. 0.20 ± 0.04 ; TLC 0.41 ± 0.14 vs. 0.50 ± 0.09 ; TF, 1. 19 ± 0.28 vs. 1.50 ± 0.26,P 〈 0.05）. The diaphragm thickness at TLC and thickening fraction presented a strongly positive with FEV1, TLC and MVV （P 〈 0.05 ）. TD shifts of subjects with COPD were reduced with values over 13.3%, significantly occurred in the moderate, severe and very se- vere airway obstruction, except for the mild one. Conclusion The application of ultrasound can sensitively show diaphragmatic spatial variable. The ultrasound observation was real - time, noninvasive and dynamic which may have potential value of clinical application.