超声评估慢性阻塞性肺疾病患者膈肌功能与肺功能关联性研究

Ultrasound Assessment of the Correlation between Diaphragm Function and Pulmonary Function in Patients with Chronic Obstructive Pulmonary Disease

目的 探讨超声评估慢性阻塞性肺疾病(COPD)患者膈肌功能与肺功能相关性。方法 选取2022年1月—2023年3月收治的100例COPD为研究组,选取同期100名体检健康者为对照组。2组均接受肺功能和超声检查,比较2组肺功能指标以及对照组与不同COPD分级患者膈肌移动度,分析COPD患者膈肌功能与肺功能相关性。结果 研究组改良医学研究委员会呼吸困难指数(mMRC)评分和残气量(RV)/肺总容量(TLC)较对照组高,而第1秒用力呼气容积(FEV1)/用力肺活量(FVC)、FVC占预计值百分比(FVC%pred)和FEV1占预计值百分比(FEV1%pred)则较对照组低(P<0.05)。重度组平静呼吸时膈肌移动度(FRC)较中度组、轻度组、对照组高,而用力呼吸时膈肌移动度(DE)、不同呼吸时相膈肌移动度差值(DE-FRC)则较中度组、轻度组、对照组低(P<0.05);中度组FRC较对照组高,而DE、DE-FRC则较轻度组和对照组低(P<0.05);轻度组DE-FRC较对照组低(P<0.05)。COPD患者膈肌功能与FEV1%pred、FVC%pred、FEV1/FVC和DE-FRC均呈正相关(r=0.595、0.436、0.637、0.576,P<0.05),而与mMRC评分、RV/TLC呈负相关(r=-0.613、-0.348,P<0.05)。结论 COPD患者膈肌功能与肺功能存在明显相关性,可通过超声评估膈肌形态了解其功能,进而为疾病诊断和治疗提供参考。

Objective To evaluate the correlation between diaphragm function and pulmonary function in patients with chronic obstructive pulmonary disease(COPD).Methods A total of 100 patients with COPD treated from January 2022 to March 2023 were selected as the research group,and 100 healthy subjects who underwent physical examination during the same period were selected as the control group.Pulmonary function and ultrasound examination were performed in both groups.The pulmonary function indexes of the two groups were compared,and the diaphragm movement of the control group and the patients with different COPD grades were compared at different breathing phases.The correlation between diaphragm function and pulmonary function in COPD patients was analyzed.Results The modified Medicine Research Council dyspnea scale(mMRC)score and residual volume(RV)/total lung volume(TLC)of the research group were higher than those of the control group.Forced expiratory volume in the first second(FEV1)/forced vital capacity(FVC),forced vital capacity as a percentage of the estimated value(FVC%pred)and forced expiratory volume in the first second as a percentage of the estimated value(FEV1%pred)were lower than those in the control group(P<0.05).The diaphragmatic movement during calm breathing(FRC)in severe group was higher than that in moderate group,mild group and control group,but the diaphragmatic movement during strenuous breathing(TLC)and the difference of diaphragmatic movement in different breathing phases(TLC-FRC)were lower than that in moderate group,mild group and control group(P<0.05).FRC in moderate group was higher than that in control group,but TLC and TLC-FRC were lower than those in mild group and control group(P<0.05).TLC-FRC in mild group was lower than that in control group(P<0.05).The diaphragm function of COPD patients was positively correlated with FEV1%pred,FVC%pred,FEV1/FVC and TLC-FRC(r=0.595,0.436,0.637,0.576,P<0.05).It was negatively correlated with mMRC score and RV/TLC score(r=-0.613,-0.348,P<0.05).Conclusion In COPD patients,there is a significant correlation between diaphragm function and pulmonary function.Ultrasound assessment of diaphragm morphology can be used to understand its function,and thus provide references for disease diagnosis and treatment.