膈肌功能参数与慢性阻塞性肺疾病患者肺功能指标的相关性及其评估病情严重程度的价值  

Correlation of Diaphragm Function Parameters with Pulmonary Function Indicators in COPD Patients and Their Value in Evaluation of Disease Severity

作　　者：魏杰 刘皎然 彭龙 周梦 张荣心 刘惠敏 林玉 王天亚 任向影 WEI Jie;LIU Jiaoran;PENG Long;ZHOU Meng;ZHANG Rongxin;LIU Huimin;LIN Yu;WANG Tianya;REN Xiangying(Department of Ultrasound Diagnosis,the 980th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Shijiazhuang 050000,China;Department of Respiratory and Critical Care,the 980th Hospital of the Joint Logistics Support Force of the People's Liberation Army of China,Shijiazhuang 050000,China;Department of Medicine,the Fourth People's Hospital of Langfang City,Langfang,Hebei 065700,China)

机构地区：[1]联勤保障部队第九八〇医院超声诊断科,石家庄050000 [2]联勤保障部队第九八〇医院呼吸与危重症科,石家庄050000 [3]廊坊市第四人民医院内科,河北廊坊065700

出　　处：《临床误诊误治》2024年第8期40-45,共6页Clinical Misdiagnosis & Mistherapy

基　　金：河北省医学科学研究课题计划(20231327)。

摘　　要：目的探究膈肌功能参数与慢性阻塞性肺疾病(COPD)患者肺功能指标的相关性及其评估病情严重程度的价值。方法选取2021年9月—2023年11月收治的100例COPD为研究对象,纳入COPD组;再依据COPD分级标准分为轻-中度组(COPDⅠ~Ⅱ级)、重度组(COPDⅢ级及以上)。同时招募与COPD组年龄、性别相匹配的健康志愿者40例作为对照组。均进行膈肌超声检查[用力呼吸(TLC)、平静呼吸(FRC)时相膈肌移动度及膈肌厚度]以及肺功能检查[第1秒用力呼气容积占预计值百分比(FEV1%pred)、用力肺活量占预计值百分比(FVC%pred)、FEV1/FVC],比较各组间膈肌功能参数差异,分析膈肌功能参数与肺功能指标的相关性及评估病情严重程度的价值。结果COPD组改良版英国医学研究会呼吸困难量表评分高于对照组,FEV1%pred、FVC%pred、FEV1/FVC均低于对照组(P<0.05)。TLC、TLC-FRC时相的膈肌移动度和膈肌厚度,重度组低于轻-中度组低于对照组(P<0.05);FRC时相膈肌移动度,重度组和轻-中度组均高于对照组(P<0.05),但重度组与轻-中度组比较差异无统计学意义(P>0.05)。膈肌移动度与COPD患者FEV1/FVC、FEV1%pred、FVC%pred呈正相关(P<0.01)。TLC时相膈肌厚度与FEV1/FVC、FEV1%pred呈正相关(P<0.05)。TLC时相膈肌移动度及膈肌厚度评估COPD病情严重程度的曲线下面积分别为0.821及0.673。结论COPD患者超声膈肌功能参数与肺功能指标具有显著相关性,超声检测膈肌功能参数对辅助评估COPD病情严重程度具有重要参考价值。Objective To explore the correlation between diaphragm function parameters and pulmonary function indicators in patients with chronic obstructive pulmonary disease(COPD)and their value in evaluation of the severity of the condition.Methods We selected 100 patients with COPD admitted from September 2021 to November 2023 as the research subjects and included them in the COPD group.According to the grading criteria for COPD,it was further divided into mild to moderate group(COPD gradesⅠ-Ⅱ)and severe group(COPD gradesⅢand above).Another 40 healthy volunteers who were age and gender matched with the COPD group were recruited as the control group.All patients underwent diaphragmatic ultrasound examination[diaphragmatic displacement(DD)and thickness during forced breathing(FRC)and calm breathing(TLC)],as well as pulmonary function examination[forced expiratory volume in one second as a percentage of predicted value(FEV1%pred),forced vital capacity as a percentage of predicted,and forced expiratory volume in one second/forced vital capacity(FEV1/FVC)].The differences in diaphragmatic function parameters between the groups were compared,and the correlation between diaphragmatic function parameters and pulmonary function indicators,as well as their value in evaluating the severity of the condition,was analyzed.Results The modified Medical Research Council(mMRC)scale score of the British Medical Research Association in the COPD group was higher than that in the control group,with FEV1%pred,FVC%pred,and FEV1/FVC were all lower than those in the control group(P<0.05).The DD and thickness during TLC and TLC-FRC phases were the lowest in the severe group,followed by the mild to moderate group and the control group(P<0.05).The DD during FRC was higher in the severe group and the mild to moderate group than in the control group(P<0.05),but there was no statistically significant difference between the severe group and the mild to moderate group(P>0.05).The DD was positively correlated with FEV1/FVC,FEV1%pred,and FVC%pred in

关 键 词：肺疾病 慢性阻塞性 超声检查 膈肌移动度 膈肌厚度 第1秒用力呼气容积 用力肺活量 相关性 受试者工作特征曲线 

分 类 号：R563.9[医药卫生—呼吸系统]