动态胸部数字化X线摄影对慢性阻塞性肺疾病患者膈肌运动功能的评估  

Application of dynamic chest digital radiography in evaluation of diaphragm motor function in patients with chronic obstructive pulmonary disease

作　　者：于刚刚[1] 王维[1] 陈疆红[2] 崔茹欣 钟朝辉[2] 徐波[1] 王浩彦[1] Yu Ganggang;Wang Wei;Chen Jianghong;Cui Ruxin;Zhong Zhaohui;Xu Bo;Wang Haoyan(Department of Respiratory Medicine,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Department of Radiology,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院呼吸科,100050 [2]首都医科大学附属北京友谊医院放射科,100050

出　　处：《国际呼吸杂志》2021年第19期1500-1505,共6页International Journal of Respiration

基　　金：北京市医院管理局"青苗"人才计划(QML20180107);首都卫生发展专项(首发2018-2-2024);北京市临床重点专科建设项目(2020-2022)。

摘　　要：目的探讨动态胸部数字化X线摄影(DR)对评价慢性阻塞性肺疾病(COPD)患者膈肌运动功能的作用。方法前瞻性研究。选取2018年6月至2019年6月首都医科大学附属北京友谊医院呼吸科95例COPD患者。根据第1秒用力呼气容积占预计值百分比(FEV1%pred)分为轻-中度组(FEV1%pred≥50%,n=52)及重-极重度组(FEV1%pred<50%,n=43)2组。在平静呼吸及尽力呼吸下行动态胸部DR,通过后处理软件分析获得横膈移动距离、速率及尽力吸气末和呼气末右侧膈肌角(右侧膈肌顶点和右肋膈角顶点连线与水平线所成夹角)的变化。2组间比较并与肺功能进行相关性分析。结果2组COPD患者在平静呼吸时左、右侧横膈移动幅度及最大运动速率差异无统计学意义;在尽力呼吸时,重-极重度组左、右两侧横隔移动幅度均小于轻-中度组(P值均<0.05),分别为左侧重-极重度(28.98±10.49)mm、左侧轻-中度(35.38±12.08)mm、右侧重-极重度24.87(12.77)mm、右侧轻-中度36.00(16.40)mm,重-极重度组左、右两侧横隔在吸气及呼气过程中最大运动速率均小于轻-中度组(P值均<0.05);尽力吸气末及尽力呼气末右侧膈肌角在重-极重度组有减少趋势,差异无统计学意义(P>0.05)。相关性分析显示,尽力呼吸时膈肌运动幅度与最大运动速率及FEV1/用力肺活量呈正相关,与残气量/肺总量呈负相关(P<0.05)。结论动态胸部DR可以简便、有效地对COPD膈肌功能进行动态评价。Objective To explore the effect of dynamic chest digital radiography(DR)on the evaluation of diaphragm motor function in patients with chronic obstructive pulmonary disease(COPD).Methods This was a prospective study.A total of 95 COPD patients were included in Department of Respiratory Medicine,Beijing Friendship Hospital,Capital Medical University from June 2018 to June 2019.The patients were divided into two groups by pulmonary function forced expiratory volume in the first second in percent predicted values(FEV1%pred),the mild-moderate group(GOLD 1 or 2,n=52)and the severe-very severe group(GOLD 3 or 4,n=43).Chest DR was performed in tidal breathing and forced breathing,the diaphragm movement amplitude,the peak motion speeds and the right diaphragm angle(formed by the line of right costal diaphragm point and the right diaphragm apex and the horizontal line)were compared between two groups.Correlation analysis was performed between the motionparameters of the diaphragms and pulmonary function.Results During tidal breathing,there was no significant difference in the diaphragm movement amplitude and peak motion speed,but the diaphragm movement amplitude in severe-very severe group was significantly less than those in mild-moderate group during forced breathing(all P<0.05)(left,[28.98±10.49]mm vs[35.38±12.08]mm,right,24.87[12.77]mm vs.36.00[16.40]mm).Peak motion speeds in inspiratory phase and expiratory phase were significantly less in severe-very severe group compared with mild-moderate group(P<0.05).No significant difference of movement amplitude of the diaphragms could be seen between the two groups(P>0.05).Correlation analysis showed that the diaphragm movement amplitude and maximum movement rate were positively correlated with FEV1/FVC,and negatively correlated with residual air volume/total lung volume(P<0.05).Conclusions Dynamic DR is a potential and effective tool for the assessment of diaphragmatic function in patients with COPD.

关 键 词：肺疾病 慢性阻塞性 动态胸部数字化X线摄影 膈肌 膈肌功能 肺功能 

分 类 号：R563.9[医药卫生—呼吸系统]