剪切波弹性成像技术在慢性阻塞性肺疾病患者病情严重程度中的诊断价值

Diagnostic value of shear wave elastography technique in the severity of patients with chronic obstructive pulmonary disease

目的探讨剪切波弹性成像(SWE)技术在慢性阻塞性肺疾病(COPD)患者病情严重程度中的诊断价值。方法选取2022年3月至10月云南大学附属医院呼吸科收治的73例稳定期COPD患者为研究对象,根据肺功能检查结果将其分为轻中度组(44例)与重度组(29例)。比较两组吸气末肋间肌厚度(ICMTei)、吸气末膈肌厚度(DTei)、肋间肌硬度(ICMswe)、膈肌硬度(Dswe);COPD患者病情严重程度的影响因素采用logistic回归分析;受试者操作特征曲线分析超声参数对COPD疾病严重程度的诊断效能;Pearson相关系数分析超声参数与COPD患者临床特征的相关性。结果重度组6分钟步行实验(6MWT)短于轻中度组,差异有统计学意义(P<0.05)。重度组ICMswe、Dswe高于轻中度组,差异有统计学意义(P<0.05);两组ICMTei、DTei比较,差异无统计学意义(P>0.05)。Dswe为重度COPD的危险因素(OR=1.309,P<0.05)。Dswe诊断重度COPD的截断值为18.75 kPa,曲线下面积为0.859(95%CI:0.772~0.945),灵敏度为89.7%,特异度为75.0%。Dswe与6MWT呈负相关(r=-0.458,P<0.01)。结论SWE技术可定量评估呼吸肌硬度,在COPD患者病情严重程度中具有诊断价值。

Objective To investigate the diagnostic value of shear wave elastography(SWE)technique in the severity of patients with chronic obstructive pulmonary disease(COPD).Methods A total of 73 patients with stable COPD admitted to Department of Respiratory,Affiliated Hospital of Yunnan University from March to October 2022 were selected as the study objects.According to the results of lung function examination,they were divided into mild-moderate group(44 cases)and severe group(29 cases).Intercostal muscle thickness at end inspiration(ICMTei),diaphragmatic thickness at end inspiration(DTei),shear wave elastography of intercostal muscle(ICMswe),and shear wave elastography of diaphragm(Dswe)were compared between two groups;the influencing factors of disease severity in COPD patients were analyzed by logistic regression;the diagnostic efficacy of ultrasonic parameters on COPD disease severity was analyzed by receiver operating characteristic curve;and Pearson correlation coefficient was used to analyze the correlation between ultrasonic parameters and clinical characteristics of COPD patients.Results The six-minute walk test(6MWT)in severe group was shorter than that in mild-moderate group,and the difference was statistically significant(P<0.05).ICMswe and Dswe in severe group were higher than those in mild-moderate group,and the difference was statistically significant(P<0.05);there were no significant differences in ICMTei and DTei between two groups(P>0.05).Dswe was a risk factor for severe COPD(OR=1.309,P<0.05).The cut-off value of Dswe in the diagnosis of severe COPD was 18.75 kPa,the area under the curve was 0.859(95%CI:0.772-0.945),the sensitivity was 89.7%,the specificity was 75.0%.Dswe was negatively correlated with 6MWT(r=-0.458,P<0.01).Conclusion SWE technique can quantitatively assess respiratory muscle hardness and has diagnostic value in the severity of COPD patients.