超声评价慢性阻塞性肺疾病患者膈肌运动异常

目的 探讨超声评价慢性阻塞性肺疾病（COPD）患者膈肌运动异常的价值。方法 收集64例COPD急性加重期患者，根据2017GOLD指南综合评估将其分为C组（n=34）和D组（n=30），以超声测量膈肌厚度、膈肌运动幅度及对合角，计算膈肌增厚分数及膈肌移动度。结果 C组膈肌增厚分数和收缩速度均明显大于D组（P均<0.05），而2组膈肌移动度和对合角差异无统计学意义（P均>0.05）。膈肌增厚分数与第1秒用力呼气量/用力肺活量（FEV1/FVC）呈正相关（r=0.26，P=0.04），膈肌移动度（r=0.35，P<0.01）、膈肌收缩速度（r=0.43，P<0.01）均与FVC呈正相关。DTF对鉴别诊断C、D组COPD性能相对较好（AUC为0.78），DTF=30.22%，其诊断敏感度70.60%，特异度83.30%。结论 超声可评价COPD患者膈肌功能障碍，指导稳定期康复治疗。

Ultrasonography in evaluation on abnormal motion of diaphragms in patients with chronic obstructive pulmonary disease

Objective To explore the value of ultrasonography in evaluation on abnormal motion of the diaphragms in patients with chronic obstructive pulmonary disease (COPD). Methods Totally 64 patients with COPD in acute exacerbation were enrolled and divided into C group (n=34) and D group (n=30) according to 2017GOLD guidelines. All patients underwent ultrasonography. The thickness of diaphragm, the range of motion of diaphragm and the angle of conjunction, as well as diaphragmatic thickening fraction (DTF) and the degree of diaphragm (DD) were measured and calculated. Results DTF and contraction speed of diaphragm in C group were significantly higher than those in D group (both P<0.05), while DD and chest wall were not significantly different between the two groups(both P>0.05). DTF was positively correlated with the ratio between forced the first second of expiratory volume and forced vital capacity (FEV1/FVC, r=0.26, P=0.04), while DD (r=0.35, P<0.01) and contraction speed (r=0.43, P<0.01)were positively correlated with forced vital capacity (FVC). The differential diagnosis performance of DTF for C group and D group COPD was relatively good (AUC=0.78), taken diagnostic threshold of 30.22%, the sensitivity and specificity was 70.60% and 83.30%, respectively. Conclusion Ultrasound can be used to evaluate diaphragmatic dysfunction in patients with COPD and guide the stable rehabilitation treatment.