动态胸片定量评价慢性阻塞性肺疾病患者用力呼吸下横膈运动的研究

Study of Using Dynamic Chest Radiography to Evaluate the Diaphragmatic Motion in COPD Patients During Forced Breathing

目的应用动态胸片定量分析用力呼吸下慢性阻塞性肺疾病(Chronic Obstructive Pulmonary Disease,COPD)患者与健康者双侧横膈运动状态的差异。方法前瞻性纳入96例COPD患者和50例健康者,在用力呼吸下行动态X线胸片检查。通过后处理软件自动分析获得横膈移动距离、时间及速率,进行两组间差异的比较及横膈移动距离与肺功能相关性分析。结果用力呼吸下COPD患者横膈移动幅度小于健康者(P<0.05),左侧_(COPD)(35.93±13.07)mm、左侧_(健康者)(41.49±12.07)mm;右侧_(COPD)(32.05±12.29)mm、右侧_(健康者)(36.88±10.96)mm。COPD患者双侧横膈移动时间均小于健康者(P<0.05),吸气时间:左侧_(COPD)2.03(1.19)s、左侧_(健康者)(2.53±0.83)s、右侧_(COPD)1.94(1.32)s、右侧_(健康者)2.23(1.21)s;呼气时间:左侧_(COPD)4.77(3.25)s、左侧_(健康者)(6.40±2.73)s;右侧_(COPD)4.94(3.30)s、右侧_(健康者)(6.72±2.58)s。两组间双侧横膈峰值速率无明显差异(P>0.05)。双侧横膈移动幅度与FEV1/FVC相关性中等(r=0.44)。结论用力呼吸下COPD患者双侧横膈移动幅度及时间均小于健康者。动态胸片可以辅助临床精准评估双侧横膈的运动状态。

Objective To quantitatively compare diaphragmatic motion during forced breathing between patients with chronic obstructive pulmonary disease(COPD)and normal subjects using dynamic chest radiography.Methods Ninety-six COPD patients and 50 healthy subjects underwent dynamic chest radiography during forced breathing in this prospective study.The distance,motion times and motion speeds of the diaphragms could be obtained by automatically analyzing with post-processing software.These parameters were compared between the two groups.Correlation coefficients were analyzed between the motion excursions of the diaphragms and pulmonary function.Results The average excursions of the diaphragms in COPD patients were significantly less than those in healthy subjects during forced breathing(P<0.05).And the left_(COPD)(35.93±13.07)mm,the left healthy(41.49±12.07)mm,respectively.Right_(COPD)(32.05±12.29)mm,right healty(36.88±10.96)mm,respectively.Motion times in inspiratory phase and expiratory phase were significantly less in COPD patients compared to healthy subjects(P<0.05),inspiratory phase:left_(COPD) 2.03(1.19)s,left healthy(2.53±0.83)s;right_(COPD) 1.94(1.32)s,right healthy 2.23(1.21)s;expiratory phase:left_(COPD) 4.77(3.25)s,left healthy(6.40±2.73)s;right_(COPD) 4.94(3.30)s,righ healthy(6.72±2.58)s.There was no significant difference of peak motion speeds between the two groups.The excursions of the bilateral diaphragms showed moderate correlation with FEV1/FVC(r=0.44).Conclusion The average excursions and motion times of the diaphragms in COPD patients were significantly less than those in healthy subjects during forced breathing.The dynamic chest radiography could be used to evaluate diaphragmatic motion accurately.