膈肌偏移与老年慢阻肺患者肺低衰减区比例及肺功能的相关性研究

Study on the relationship of diaphragmatic activity with the proportion of low attenuation area and lung function in elderly patients with COPD

目的评估膈肌偏移与老年慢阻肺患者肺低衰减区比例及肺功能之间的相关性,并探讨其对老年慢阻肺患者气流受限严重程度的判断价值。方法选取2020年6月到2021年12月在我院住院的慢阻肺急性加重期患者100例为研究对象,所有患者均行膈肌彩超、胸部高分辨率CT、肺功能检查,比较不同等级慢阻肺患者膈肌偏移、肺低衰减区比例(LAA%-950)及肺功能参数的差异,并进行相关性分析。结果1.100名慢阻肺患者GOLDⅠ级~Ⅳ级FEV_(1)%pred分别为:(85.48±2.98)%、(63.34±9.20)%、(42.95±5.74)%、(27.11±2.94)%,各GOLD组间肺功能参数:FEV_(1)%pred、FEV_(1)、FVC差异均有统计学意义(P<0.05);2.各GOLDⅠ级~Ⅳ级膈肌偏移分别为:(53.81±6.23)mm、(45.09±6.38)mm、(34.08±5.07)mm、(20.59±4.54)mm,各GOLD组间膈肌偏移差异均有统计学意义(P<0.05),且膈肌偏移随着GOLD分级的升高而降低;3.各GOLDⅠ级~Ⅳ级肺低衰减区域比例分别为:(8.02±5.78)%、(15.53±5.36)%、(18.62±2.75)%、(26.11±4.39)%,各GOLD组间差异有统计学差异(P<0.05),且LAA%-950随着GOLD分级的升高而升高。膈肌活动度与FEV_(1)%pred、FEV_(1)、FVC均呈正相关,其中FEV_(1)%pred与膈肌活动度的相关性最高,呈强相关(r>0.7),即FEV_(1)%pred越高,膈肌偏移越大;4.膈肌偏移与LAA%-950呈负相关(r<-0.7),即LAA%-950越高,膈肌活动度越差。结论膈肌偏移与慢阻肺患者肺低衰减区域及气流受限严重程度有显著相关性,肺过度充气导致膈肌活动度下降,膈肌活动度能够较准确的评估慢阻肺患者严重程度,可为患者早期诊断及预后干预提供客观性依据。

Objective To evaluate the correlation of diaphragm migration with the proportion of low attenuation area and lung function in elderly patients with COPD,and to explore its value in determining the severity of airflow restriction in elderly patients with COPD.Methods A total of 100 patients with acute exacerbation of COPD in our hospital from June 2020 to December 2021 were selected as the study objects.All patients underwent diaphragm color ultrasound,chest high-resolution CT and lung function examination.The differences of diaphragm migration,proportion of lung low attenuation area(LAA%-950)and lung function parameters in patients with different grades of COPD were compared.And correlation analysis was carried out.Results 1.FEV_(1)%pred of 100 patients with COPD in grade I~Ⅳwere(85.48±2.98)%,(63.34±9.20)%,(42.95±5.74)%,and(27.11±2.94)%respectively.Lung function parameters among GOLD groups were as follows:the differences of FEV_(1)%Pred,FEV_(1)and FVC were statistically significant(P<0.05).2.The diaphragmatic migration of GOLD I~Ⅳgrade was:(53.81±6.23)mm,(45.09±6.38)mm,(34.08±5.07)mm,and(20.59±4.54)mm.There were statistically significant differences in diaphragmatic migration among all GOLD groups(P<0.05),and the diaphragmatic migration decreased with the increase of GOLD grade.3.The proportion of low attenuation area of GOLDⅠ~Ⅳlung was as follows:(8.02±5.78)%,(15.53±5.36)%,(18.62±2.75)%,and(26.11±4.39)%.There were statistical differences among all GOLD groups(P<0.05),and the LAA%-950 increased with the increase of GOLD grade.FEV_(1)%pred,FEV_(1)and FVC were all positively correlated with diaphragm activity,and the correlation between FEV_(1)%pred and diaphragm activity was the highest,showing a strong correlation(r>0.7).The higher the FEV_(1)%pred,the greater the diaphragm migration.4.Diaphragm migration was negatively correlated with LAA%-950(r<-0.7).The higher the LAA%-950,the worse the diaphragm activity.Conclusion Diaphragmatic migration is significantly correlated with the severity of low attenuation area and restricted airflow in patients with COPD.Lung hyperinflation leads to decreased diaphragmatic activity.Diaphragmatic activity can accurately assess the severity of patients with COPD,and can provide objective basis for early diagnosis and prognostic intervention.