超声监测膈肌活动对慢性阻塞性肺病患者病情判定的价值初探  

Preliminary exploration of ultrasound for monitoring the diaphragmatic muscles mobility in patients with chronic obstructive pulmonary disease

作　　者：徐颖[1] 张锐利[1] 邓建永[2] 李俊[3] XU Ying;ZHANG Ruili;DENG Jianyong;LI Jun(Department of Ultrasound,Meishan City People＇Hospital,Sichuan 620010,China)

机构地区：[1]四川省眉山市人民医院超声科,620010 [2]四川省眉山市人民医院放射科,620010 [3]四川省眉山市人民医院呼吸科,620010

出　　处：《临床超声医学杂志》2018年第10期679-683,共5页Journal of Clinical Ultrasound in Medicine

摘　　要：目的探讨M型超声法、B超直接法和B超间接法三种超声检测方式监测膈肌活动对慢性阻塞性肺疾病(COPD)患者病情判定的意义。方法以第1秒用力呼气容积(FEV1)占预计值50%为分界线,选取高风险COPD患者(FEV1<50%,高风险组)和低风险COPD患者(50%≤FEV1≤70%低风险组)各40例,记录并比较两组一般情况、肺功能、血气,以及三种超声检查和X线检查的膈肌移动度。应用单因素和多因素分析筛选影响COPD患者病情严重程度的指标,分析三种超声检查结果和X线检查结果的相关性。绘制ROC曲线评价三种超声检查方法预测COPD严重程度的价值。结果高风险组M型超声法移动度、B超直接法移动度、B超间接法移动度和X线移动度均低于低风险组,差异均有统计学意义(均P<0.05)。M型超声法移动度、B超直接法移动度、B超间接法移动度和X线移动度均是高风险组患者的独立影响因素。M型超声法移动度、B超直接法移动度、B超间接超移动度均与X线移动度呈正相关(r=0.738、0.667、0.634,均P<0.05)。M型超声法和X线检查联合应用诊断COPD的ROC曲线下面积最大(0.781)。结论 M型超声法、B超直接法和B超间接法均可用于COPD病情判定,M型超声法和X线联合诊断的效果更佳。Objective To explore the significance of M-mode ultrasound, B-mode direct ultrasound and B-mode indirect ultrasound in monitoring the diaphragmatic muscles mobility in patients with chronic obstructive pulmonary disease （COPD）. Methods Taking forced expiratory volume in the first second（FEV1 ） accounted for 50% of the estimated value as the dividing line,forty patients with high risk COPD（high risk group, FEV1 〈50%） and 40 low risk COPD patients（ low risk group, 50% -〈 FEV1 -〈70% ） were selected.The basic information,lung function,blood gas,and the diaphragmatic muscles mobility by three kinds of ultrasound and X-ray of two groups were recorded.Single-factor and multi-factor analysis were used to screen indicators that affect the severity of COPD.The correlation between the three ultrasound methods and X-ray was analyzed.ROC analysis was used to evaluate the value of three kinds of ultrasound methods to predict the severity of COPD.Results The mobility of M-mode ultrasound, B-mode direct ultrasound, B-mode indirect ultrasound,and X- ray in high risk group were lower than those in low risk group（all P〈0.05）.The mobility of M-mode ultrasound, B-mode direct ultrasound, B-mode indirect ultrasound,and X- ray were the independent factors of high risk COPD patients.The mobility of M-mode ultrasound,B-mode direct ultrasound,B-mode indirect ultrasound and X- ray had significant positive correlation （r=0.738,0.667,0.634, all P〈0.05）.The area under the ROC curve of diagnosis of COPD was the largest in the combination of M-mode ultrasound and X-ray（0.781 ）.Conclusion M-mode ultrasound, B-mode direct ultrasound and B-mode indirect ultrasound can be used for the diagnosis of COPD,the combination of M-mode ultrasound and X-ray is more effective.

关 键 词：超声检查 慢性阻塞性肺病 膈肌活动度 

分 类 号：R445.1[医药卫生—影像医学与核医学]