超声评价膈肌活动度与慢性阻塞性肺疾病患者生活质量及运动能力的相关性研究

The relationship of diaphragmatic mobility evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease

目的应用超声探讨膈肌活动度与慢性阻塞性肺疾病(简称慢阻肺)患者生活质量及运动能力的相关性,并分析影响膈肌活动度的因素。方法选择2015年10月至2017年3月在河南中医药大学第一附属医院就诊的男性慢阻肺稳定期患者48例。测定患者身高、体重、膈肌活动度[M型超声测定深呼吸时膈肌运动幅度(ΔM)]、气流阻塞程度[第1秒用力呼气容积占预计值百分比(FEV1%pred)]和运动能力[6分钟步行距离(6MWD)]。采用圣乔治呼吸问卷(SGRQ)评价患者的生活质量。结果 48例慢阻肺患者ΔM最小值1.89 cm,最大值8.11 cm。ΔM与患者SGRQ评分的总分、症状分、影响分、活动分以及6MWD均相关,相关系数分别为–0.474、–0.416、–0.432、–0.502和0.536。多元逐步回归分析发现影响ΔM的因素是身高(β=0.407,P=0.021)和FEV_1%pred(β=–0.391,P=0.035)。结论慢阻肺患者膈肌活动度与生活质量有密切的关系,身高及FEV_1%pred对膈肌活动度影响最大。患者膈肌活动度越小,生活质量越差,活动能力越小。

Objective To investigate the relationship of diaphragmatic mobility （AM） evaluated by ultrasonography with quality of life and athletic ability in patients with chronic obstructive pulmonary disease （COPD）, and analyze the factors those affect the diaphragmatic mobility. Methods A total of 48 male patients with stable COPD were recruited in the study. The body height, body weight, diaphragmatic mobility, airflow obstruction （FEV1%pred）, and exercise capacity （6MWD） were measured. The quality of life was assessed using the St. George＇s Respiratory Questionnaire （SGRQ）. Results The minimum value of AM was 1.89 cm and the maximal value was 8.11 cm in the COPD patients. There were significant correlationship between AM and the SGRQ score of the total score, symptom score, impact points, activity points and 6MWD, with correlation coefficients of -0.474, -0.416, -0,432, -0.502 and 0.536, respectively. Multivariate stepwise regression analysis showed that the factors influencing AM were height （β=0.407, P=0.021） and FEV1%pred （β=-0.391, P=0.035）. Conclusions Diaphragmatic mobility and quality of life are closely related in COPD patients. The height and FEV1%pred have the greatest effect on diaphragmatic activity. The smaller diaphragm mobility is relevant to the worse quality of life and the smaller activity capacity.