成年健康人群膈肌超声正常值参考范围及影响因素  

Reference ranges for normal values of diaphragmatic ultrasound indices and influencing factors in healthy adults

作　　者：赵浩天[1] 王晓娜[1] 刘奕 李丽[1] 刘凯 姚光耀 薛红元[1] 赵鹤龄[4] Haotian Zhao;Xiaona Wang;Yi Liu;Li Li;Kai Liu;Guangyao Yao;Hongyuan Xue;Heling Zhao(Department of Ultrasound,Hebei General Hospital,Shijiazhuang 050051,China;Department of Critical Care Medicine,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Respiratory and Critical Care Medicine,Hebei General Hospital,Shijiazhuang 050051,China;Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院超声科,石家庄050051 [2]复旦大学附属中山医院重症医学科,上海200032 [3]河北省人民医院呼吸与危重症医学科,石家庄050051 [4]河北省人民医院重症医学科,石家庄050051

出　　处：《中华医学超声杂志(电子版)》2024年第11期1057-1067,共11页Chinese Journal of Medical Ultrasound(Electronic Edition)

基　　金：河北省医学科学研究计划项目(20230347,20211264)。

摘　　要：目的构建成年健康人群膈肌超声指标正常值参考范围并分析相关影响因素。方法本研究为前瞻性、观察性研究,选择2023年12月至2024年9月河北省人民医院门诊或体检的健康受试者、本院职工及家属共1035人,使用超声获取膈肌移动度(DD)、深吸气膈肌移动度(DDdi)、膈肌收缩期峰值速度(DPSV)、膈肌舒张期峰值速度(DPDV)、呼气末膈肌厚度(DD-ee)、吸气末膈肌厚度(DD-ei)、深吸气末膈肌厚度(DD-edi)、膈肌增厚率(DTF)、深吸气膈肌增厚率(DTF-di)、胸膜滑动位移(PSD),并计算DD储备值、DT储备值和DTF储备值。根据年龄分层分为18~39岁组、40~59岁组、60~79岁组、80~99岁组,计算各组间整体及不同性别各超声指标,以计量资料各指标区间的第5%、第95%位数值作为正常值参考范围的下限和上限。采用Pearson法或Spearman法进行年龄、性别、体质量指数(BMI)、呼吸频率与上述膈肌超声参数的相关性分析,采用组内相关系数(ICC)评价观察者内及观察者间重复性。结果(1)不同年龄段之间,80~99岁组(21人)DD、DD-di、DD储备值、DT-ei、DT-edi、DT储备值、DTF、DTF-di、DTF储备值均低于18~39岁组(344人)、40~59岁组(403人)及60~79岁组(267人),PSD低于18~39岁组及40~59岁组。60~79岁组DD-di、PSD低于18~39岁组及40~59岁组,DD储备值、DTedi、DT储备值、DTF-di、DTF储备值均低于18~39岁组,DPDV高于40~59岁组。40~59岁组DD-di、DD储备值、DTF-di、DTF储备值均低于18~39岁组(P均<0.05)。(2)各年龄段不同性别之间,总例数组内,男性DD-di、DD储备值、DT-ee、DT-ei、DT-edi、DT储备值均高于女性。18~39岁组内,男性DD-di、DD储备值、DT-ee、DT-ei、DT-edi均高于女性,DTF、DTF-di均低于女性。40~59岁组内,男性DD-di、DD储备值、DT-ee、DT-ei、DT-edi、DT储备值均高于女性。80~99岁组内,男性DD-di、DT-ee、DT-ei、DT-edi、DT储备值均高于女性(P均<0.05)。(3)性别与DT-ee呈中度负相关性(r ObjectiveTo establish the reference ranges for normal values of diaphragmatic ultrasound indices in healthy adult populations and analyze the related influencing factors.MethodsThis is a prospective, observational study in which 1035 healthy subjects, staff and family members of Hebei General Hospital from December 2023 to September 2024 were enrolled. Ultrasound was used to obtain diaphragm displacement (DD), deep inspiratory DD (DD-di), peak systolic velocity of the diaphragm (DPSV), peak diastolic velocity of the diaphragm (DPDV), end expiratory diaphragm thickness (DT-ee), end inspiratory DT (DT-ei), end deep inspiratory DT (DT-edi), diaphragm thickening fraction (DTF), deep inspiratory DTF(DTF-di), and pleural sliding displacement (PSD). The DD reserve value and DT reserve value were also calculated. Subjects were stratified by age into groups of 18-39 years, 40-59 years, 60-79 years, and 80-99 years. The ultrasound indices were compared among the groups and between genders within each group.The 5th and 95th percentiles of each index in the quantitative data were used as the lower and upper limits of the reference ranges. Pearson’s or Spearman’s method was used to analyze the correlation between age, sex,body mass index(BMI), respiratory frequency and the above phrenic ultrasound parameters, and intraclass correlation coefficient (ICC) was used to assess the intra- and inter-observer reproducibility.ResultsAmong the different age groups, the group of 80-99 years had lower DD, DD-di, DD reserve value, DT-ei, DT-edi,DT reserve value, DTF, DTF-di, and DTF reserve value compared to the 18-39 years, 40-59 years, and 60-79 years groups, and lower PSD compared to the 18-39 years and 40-59 years groups. The 60-79 years group had lower DD-di and PSD compared to the 18-39 years and 40-59 years groups, and the 60-79 years group had lower DD reserve value, DT-edi, DT reserve value, DTF-di, and DTF reserve value compared to the 18-39 years group, and higher DPDV compared to the 40-59 years group. The 40-59 years grou

关 键 词：膈肌 超声检查 正常值 健康人群 影响因素 

分 类 号：R445.1[医药卫生—影像医学与核医学] R561[医药卫生—诊断学]