慢性阻塞性肺疾病患者膈肌厚度分数与活动耐力和呼吸困难相关性研究  

Influence of diaphragm thickening fraction on exercise tolerance and dyspnea in patients with chronic obstructive pulmonary diseases

作　　者：张黎娟[1] 王飞飞[1] 马少林[2] 朱晓萍[3] 

机构地区：[1]宁夏医科大学临床医学院,宁夏银川750004 [2]同济大学附属东方医院中心ICU,上海200120 [3]同济大学附属东方医院呼吸科,上海200120

出　　处：《中国实用内科杂志》2017年第6期552-554,575,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81170074);上海市卫生局科研课题2010版(20134336)

摘　　要：目的观察慢性阻塞性肺疾病(慢阻肺)患者膈肌厚度变化,评价其与活动耐力和呼吸困难的关系。方法选取2015年8月至2016年8月上海市东方医院呼吸门诊收治的慢阻肺患者50例,同时选取该院职工肺功能正常的30名年龄与之接近的健康人作为对照组。分别行肺功能检查,在功能残气(FRC)、肺总量(TLC)位超声测量膈肌厚度(TD),计算膈肌厚度分数(TF,从FRC至TLC位膈肌厚度的变化),6 min步行距离(6MWT)、呼吸困难指数(m MRC);分析慢阻肺患者TD变化与肺功能和活动能力的相关性。结果慢阻肺组TLC位膈肌厚度和厚度分数分别为(0.38±0.10)cm和1.02±0.45,与健康对照组[(0.49±0.09)cm和(1.41±0.47)]比较差异有统计学意义(P<0.05)。厚度分数与6MWT呈正相关(r=0.591,P<0.01),与m MRC呈负相关(r=-0.472,P=0.001)。根据厚度分数水平,将慢阻肺组分为2亚组:G1(≤1.458),G2(>1.458)。G1组6MWT为(371.95±95.73)m,较G2组[(512.00±108.61)m]降低(P<0.05);G1组mMRC为2.63±1.08,较G2组(1.70±0.82)增高(P<0.05);G1组气道阻塞(FEV_1)为(47.41±16.70)L,最大自主通气量(MVV)为(46.32±17.97)L,两者较G2组[FEV_1为(69.96±16.82)L,MVV(62.60±22.13)L]下降(均P<0.05)。结论慢阻肺患者膈肌厚度和厚度分数下降影响患者活动耐力和呼吸困难。Objective To evaluate change of diaphragm thickness in COPD patients, and to assess its influence on exercise tolerance and dyspnea in COPD. Methods Fifty subjects with COPD and 30 age-matched control subjects were included in the present study. All subjects were performed with the pulmonary function examination and ultrasound measurement of diaphragm thickness at FRC and TLC. The diaphragm thickening fraction was calculated by diaphragm thickness from FRC to TLC.The correlation of diaphragm thickness and thickening fraction with pulmonary function and exercise capacity was assessed. Result The COPD patients presented with lower diaphragm thickness at TLC （TD） and thickening change fraction（TF） compared with the control subjects （TD 0.38±0.10 vs. 0.49±0.09; TF 1.02±0.45 vs. 1.41±0.47, respectively, P〈0.05）. The diaphragm thickening fraction presented a linear positive correlation with 6MWT （r=0.S91, P〈0.01） and negative with dyspnea （r=-0.472, P〈0.01）. Additionally, COPD patients were divided into two subgroups based on the degree of diaphragm thickening fraction： G1（≤1.458）, G2（ 〉 1.458）. The G1 subjects presented poorer 6MWT and greater dyspnea when compared with the G2 patients （6MWT 371.95±95.73 vs. 512.00±108.61; dyspnea 2.63±1.08 vs. 1.70±0.82, P〈0.05）. The G1 also presented lower airway obstruction （FEV1 47.41±16.70 vs. 69.96±16.82, P〈0.05） and maximal voluntary ventilation （MVV 46.32±17.97 vs. 62.60±22.13, P〈0.05） than the G2. Conclusion The reduction of diaphragm thickness and thickening fraction contributes to the exercise tolerance and dyspnea in COPD.

关 键 词：超声 慢性阻塞性肺疾病 膈肌 活动耐力 呼吸困难 

分 类 号：R563[医药卫生—呼吸系统]