慢性阻塞性肺疾病动态胸X线片膈肌运动与呼吸功能评估的意义

Significance of dynamic chest radiograph diaphragm motion and assessment of respiratory function in chronic obstructive pulmonary disease

目的:评价动态胸X线片膈肌运动在慢性阻塞性肺疾病(COPD)呼吸功能评估中的意义。方法:选取我院就诊的96例稳定期COPD患者和50例健康受试者,完成肺功能检查及动态胸片检查。获得肺通气功能及动态胸X线片横膈移动幅度、速度及时间等参数。分析并对比两组间肺功能和动态胸片各参数的差异,评估动态胸片各参数在COPD呼吸功能评估中的价值。结果:COPD组FEV1、FEV1%pre以及FEV1/FVC均低于健康受试组,且差异均有统计学意义(P<0.01)。平静呼吸时,COPD组双侧膈肌运动幅度、双侧膈肌上升速度和双侧膈肌下降速度均高于健康受试组,且均差异有统计学意义(P<0.05)。用力呼吸时,COPD患者吸气时间和呼气时间以及双侧膈肌运动幅度均小于健康受试者,且均差异有统计学意义(P<0.05)。用力呼吸时,双侧膈肌运动幅度与肺功能各项指标均成正相关。对动态胸X线片参数做K-均值聚类分析,各变量对聚类结果的重要程度前五位分别为:用力呼吸左侧膈肌运动幅度(F=86.88),用力呼气左侧膈肌运动速度(F=79.37),用力吸气左侧膈肌运动速度(F=77.41),用力吸气右侧膈肌运动速度(F=72.28),用力呼吸右侧膈肌运动幅度(F=54.46)。结论:动态胸X线片可以精准评估双侧横膈的运动状态,与肺功能参数一致性好,可以作为COPD的肺功能评估的补充工具。

Objective:To evaluate the application value of dynamic chest radiograph in the prediction and diagnosis of chronic obstructive pulmonary disease(COPD).Methods:96 patients with stable COPD and 50 healthy subjects were selected from our hospital to complete pulmonary function tests and dynamic chest X-ray examinations.Parameters such as pulmonary ventilation function and dynamic chest X-ray diaphragm movement amplitude,speed and time were obtained.The differences in pulmonary function and dynamic chest X-ray parameters between the two groups were analyzed and compared,and the value of dynamic chest X-ray parameters in the assessment of COPD respiratory function was evaluated.Results:FEV1,FEV1%pre and FEV1/FVC in the COPD group were lower than those in the healthy control group,and the difference was statistically significant(P<0.01).During calm breathing,the range of motion of bilateral diaphragms,the ascending velocity of bilateral diaphragms and the descending velocity of bilateral diaphragms in the COPD group were higher than those in the healthy control group,and the differences were statistically significant(P<0.05).During forced breathing,the inspiratory time,expiratory time and bilateral diaphragm movement range in COPD patients were all smaller than those in healthy subjects,and the differences were statistically significant(P<0.05).During forced breathing,the amplitude of bilateral diaphragmatic movement was positively correlated with various indicators of pulmonary function.K-means cluster analysis was performed on the dynamic chest X-ray parameters,and the top five importance of each variable to the clustering results were:the left diaphragm motion range for forced breathing(F=86.88),and the left diaphragm movement speed for forced exhalation(F=79.37),the movement speed of the left diaphragm with forced inspiration(F=77.41),the movement speed of the right diaphragm with forced inspiration(F=72.28),the movement range of the right diaphragm with forced inspiration(F=54.46).Conclusions:Dynamic chest X-ray can accurately assess the motion state of bilateral diaphragms,which is consistent with pulmonary function parameters,and can be used as a supplementary tool for pulmonary function assessment in COPD.