超声剪切波弹性成像在职业性慢阻肺患者病情评估中的应用价值

The application value of ultrasonic shear wave elastography in the assessment of occupational chronic obstructive pulmonary disease patients

目的 探讨超声剪切波弹性成像(SWE)在职业性慢性阻塞性肺疾病(慢阻肺)患者病情评估中的应用价值。方法 选取89例职业性慢阻肺患者,依据肺功能检查结果不同分为轻中度组(55例)与重度组(34例)。两组均行超声剪切波弹性成像检查。比较两组呼吸肌参数[吸气末肋间肌厚度(ICMTei)、肋间肌硬度(ICMswe)、吸气末膈肌厚度(DTei)、膈肌硬度(Dswe)],绘制受试者工作特征曲线(ROC曲线),分析ICMswe、Dswe及联合检测诊断重度职业性慢阻肺的价值,分析不同严重程度患者呼吸肌超声剪切波弹性成像成像表现。结果 重度组ICMswe(26.63±2.24)kPa、Dswe(23.12±2.24)kPa较轻中度组的(23.24±2.15)、(16.81±1.43)kPa高(P<0.05)。ROC曲线显示,ICMswe、Dswe及联合检测诊断重度职业性慢阻肺的曲线下面积(AUC)分别为0.857、0.854、0.964,联合检测价值最高。超声剪切波弹性成像检查时,图像上颜色可显示组织硬度变化,因轻中度患者呼吸肌硬度偏低,故多为浅绿色,重度患者硬度高,则多为黄绿色。结论 超声剪切波弹性成像检查在职业性慢阻肺患者病情评估中价值高,可准确鉴别重度患者,有助于指导临床完善治疗方案,实现病情的稳定控制。

Objective To explore the application value of ultrasonic shear wave elastography(SWE in the assessment of occupational chronic obstructive pulmonary disease patients.Methods 89 patients with occupational chronic obstructive pulmonary disease were selected and divided into a mild-to-moderate group(55 patients) and a severe group(34 patients) according to the results of pulmonary function tests.Both groups underwent ultrasonic shear wave elastography.Respiratory muscle parameters [intercostal muscle thickness at end-inspiratory(ICMTei),shear wave elastography of intercostal muscle(ICMswe),diaphragm thickness at endinspiration(DTei),shear wave elastography of diaphragm(Dswe)] were compared between the two groups,and the receiver operating characteristic(ROC) curves were plotted to analyze the value of the ICMswe,Dswe,and combined test in the diagnosis of severe occupational chronic obstructive pulmonary disease.The ultrasonic shear wave elastography imaging in the patients with different degrees of severity was analyzed.Results The severe group had ICMswe of(26.63±2.24) kPa and Dswe of(23.12±2.24) kPa,which were higher than(23.24±2.15)and(16.81±1.43) kPa in mild-to-moderate group(P<0.05).ROC curve showed that the area under the curve(AUC) of ICMswe,Dswe and combined test in the diagnosis of severe occupational COPD were 0.857,0.854 and 0.964,respectively,and the combined test had the highest value.During ultrasonic shear wave elastography,the color on the image can show the change of tissue hardness.Due to the low hardness of respiratory muscle in mild and moderate patients,it is mostly light green;in severe patients,it is mostly yellow green.Conclusion Ultrasonic shear wave elastography is of high value in the assessment of the condition of patients with occupational chronic obstructive pulmonary disease,and can accurately identify severe patients,which can help to guide clinical improvement of treatment plan and achieve stable control of the disease.