横膈高度指数在儿童膈膨升中的临床意义

Clinical significance of diaphragmatic height index in pediatric diaphragmatic eventration

目的检测中国儿童横膈高度指数(diaphragmatic height index,DHI)正常值范围,探讨其在膈膨升患儿中的临床意义。方法收集2007年1月至2019年8月在上海交通大学医学院附属新华医院确诊为膈膨升的52例患儿相关资料。其中,男39例,女13例;平均年龄为15.7个月,范围在2.0~132.0个月,将此52例患儿作为膈膨升组。收集同时期排除心肺疾病、脊柱侧弯畸形及无产伤外伤史儿童的胸部前后位X线片,共280例,作为正常儿童组,按年龄将280例儿童分为4个年龄段:①年龄<1岁儿童共80例;②1岁≤年龄<5岁儿童共68例;③5岁≤年龄<9岁儿童共56例;④9岁≤年龄<12岁患儿共76例。同时测定60例正常成年人的DHI,作为成人组。根据胸部X线片测量胸椎T10上下缘之间距离(vertebrae height,VH)和一侧抬高的横膈最高点与对侧横膈最高点平行线之间的距离(diaphragmatic highest distance,DHD),按公式DHI=DHD/VH计算得出DHI值。数据间差异使用Mann-Whitney U检验和Kruskal Wallis检验。结果①正常儿童组各年龄段DHI值分别为0.95±0.42(年龄<1岁),0.70±0.31(1岁≤年龄<5岁),0.59±0.22(5岁≤年龄<9岁),0.65±0.28(9岁≤年龄<12岁),成人组DHI值为0.67±0.31。年龄≥1岁各年龄段正常儿童及成人比较,DHI值的差异无统计学意义(P>0.05),DHI值保持稳定。②膈膨升组年龄<1岁的患儿DHI值(4.67±1.65)与年龄<1岁的正常儿童组DHI值(0.95±0.42)比较,差异具有统计学意义(P<0.001);年龄≥1岁的患儿DHI值(3.35±1.09)与年龄≥1岁的正常儿童组及成人组DHI值(0.65±0.29)比较,差异具有统计学意义(P<0.001)。③52例膈膨升患儿中14例反复发生呼吸道感染,38例偶发呼吸道感染、症状轻,反复感染患儿和偶发感染患儿的DHI值分别为4.25和4.38,差异无统计学意义(P=0.85)。结论DHI值是一种评价膈膨升的客观指标,测量方法简单、易操作,可用于临床实践。

Objective To detect the normal range of diaphragmatic height index(DHI)in Chinese children and explore clinical significance in pediatric diaphragmatic eventration(DE).Methods From January 2007 to August 2019,DE group was composed of 52 children,including 39 boys and 13 girls with a mean age of 15.7(2.0 to 132.0)months.In control group,280 children without cardiopulmonary disease,scoliosis deformity or history of birth injury/trauma were divided into 4 age groups:①aged<1 year(n=80);②aged<5 years(n=68);③aged<9 years(n=56)and④aged<12 years(n=76).DHI was measured in another 60 normal adults as adult control group.Distance between upper and lower margins of T10 of thoracic spine(vertebrae height,VH),distance between the highest point of elevated diaphragm at one side and parallel line of the highest point of diaphragm at an opposite side(diaphragmatic highest distance,DHD)were measured according to chest radiography and DHI values were calculated according to the formula:DHI=DHD/VH.Statistical processing was performed by Mann-Whitney U and Kruskal Wallis tests.Results①DHI values for each age group of normal children were(0.95±0.42)for ages<1 year,(0.70±0.31)for 1 year≤aged<5 years,(0.59±0.22)for 5 years≤age<9 years and(0.65±0.28)for 9 years≤age<12 years respectively,and(0.67±0.31)for adult group and the differences in DHI value were not statistically significant(P>0.05).DHI values stabilized after 1 year of age(≥1 year).②There was significant difference between the DHI value of children aged under 1 year in the diaphragmatic swelling group(4.67±1.65)and that of normal children aged less than 1 year(0.95±0.42)(P<0.001).The DHI value of children aged≥1 year old(3.35±1.09)was significantly higher than that of normal children and adults aged≥1 year old(0.65±0.29)(P<0.001).③In DE group,there were 14 children with recurrent respiratory infections and 38 children with occasional respiratory infections but with mild symptoms,with DHI values of 4.25 and 4.38 respectively.There was no statistically significant difference(P=0.85).Conclusions DHI value is an objective parameter for evaluating diaphragmatic elevation.And it is simple and easy to measure for clinical practice.