慢性阻塞性肺疾病患者步态分析的初步研究

Gait analysis in patients with chronic obstructive pulmonary disease:a preliminary study

目的探讨慢性阻塞性肺疾病(COPD)患者与健康人之间步态分析的差异,评估气流受限程度和系统性炎症对慢阻肺患者步态的影响,从而及早预测慢阻肺患者的跌倒风险并制定跌倒预防策略。方法选取2020年10月至2021年5月来苏州大学附属无锡九院呼吸科门诊就诊的稳定期COPD患者60例及健康体检者(对照组)36例,均行步态分析、坐-站起立测试、肺功能及外周血检查。首先比较COPD组与对照组之间步态分析等的差异;然后将COPD患者依据慢性阻塞性肺疾病全球倡议(GOLD)肺功能分级分为轻中度组,重度组和极重度组,分析气流受限程度对步态特征的影响;最后分析不同肺功能的COPD患者的炎症指标与步态分析之间的关系。结果COPD组的步速、步行距离、步频、步长、摆动相时间、双足支撑时间、踝关节角速度、站立时长、步行周期、支撑相时间、髋关节屈、膝关节角速度、踝关节屈、踝关节伸及坐位时长与健康对照组之间有统计学差异(P<0.05);不同肺功能分级的COPD患者中,优势侧步频与第一秒用力呼气容积(FEV1)有相关性(P<0.05);不同肺功能分级的COPD患者中,中性粒细胞淋巴细胞比值(NLR)与FEV1呈正向弱相关,并且NLR与支撑相时间、站立时长及坐位时长均呈正向弱相关,与踝关节伸(跖屈角度)及踝关节角速度呈负向弱相关,血小板淋巴细胞比值(PLR)与中性粒细胞淋巴细胞比值(NLR)有相似结果(除支撑时间)。结论COPD患者的活动耐力及步态稳定性明显低于健康对照者,并且随着其肺功能的进展,步态稳定性越差;炎症指标中性粒细胞淋巴细胞比值(NLR)及血小板淋巴细胞比值(PLR)与肺功能及步态分析之间也有一定的相关性。因此定量步态分析可以早期发现COPD患者异常的步态参数,及早识别患者的跌倒风险,从而进行早期干预。

Objective To investigate the difference in gait between patients with chronic obstructive pulmonary disease(COPD)and healthy subjects,and to evaluate the impact of airflow restriction and systemic inflammation on gait of patients with COPD,so as to predict the risk of falls in patients with COPD early and develop prevention strategies for fall.Methods From October 2020 to May 2021,60 COPD patients with stable COPD and 36 healthy subjects(control group)were selected at Wuxi No.9 People's Hospital Affiliated to Soochow University.Gait analysis,sitting-standing up test,and lung function and peripheral blood examination were performed.First,the difference in gait between COPD patients and the control group was compared.Then,patients with COPD were divided into a mild-to-moderate group,severe group,and very severe group according to Global Initiative for Chronic Obstructive Lung Disease(GOLD)classification,and the effect of airflow restriction on gait characteristics was analyzed.Finally,the relationship between inflammatory indexes and gait in COPD patients with different lung functions was analyzed.Results Pace,walking distance,stride length,step length,swing phase time,foot support,ankle joint angular velocity,standing time,walking cycle,support phase time,hip flexion,knee joint angular velocity,ankle flexion and stretch,and seat time differed significantly between the two groups(P<0.05).In COPD patients with different lung function grades,dominant side gait frequency was correlated with forced expiratory volume in the first second(FEV1)(P<0.05);neutrophil-lymphocyte ratio(NLR)was weakly positively associated with FEV1,support phase time,standing time,and seat time,and was weakly negatively associated with ankle stretch(plantar flexion angle)and ankle angular velocity is negative correlation;platelet-to-lymphocyte ratio(PLR)has similar results to NLR(except support time).Conclusion The activity endurance and gait stability of COPD patients are significantly lower than those of healthy controls,and with the deterioration of lung function,gait stability becomes worse.Inflammatory indicators NLR and PLR also correlate with lung function and gait.Therefore,quantitative gait analysis can be used to detect abnormal gait parameters in COPD patients early,and identify patients at risk of falling early,so as to carry out early intervention.