摘要
目的探讨动态胸部X线片(DCX)在慢性阻塞性肺疾病(COPD)患者膈肌功能障碍的应用价值。方法本研究为横断面研究。采用目的抽样法收集2022年3-12月在广州医科大学第一附属医院住院确诊为COPD患者20例(COPD组),通过年龄:性别匹配招募健康对照受试者20例(对照组)。通过DCX检测右侧横膈最大移动量(RDEmax)、左侧横膈最大移动量(LDEmax)、右肺最大面积(RLAmax)、左肺最大面积(LLAmax)、总肺最大面积(TLAmax)、右肺最小面积(RLAmin)、左肺最小面积(LLAmin)、总肺最小面积(TLAmin)、右肺面积变化率(CRr)、左肺面积变化率(CRl)、总肺面积变化率(CRt),比较2组DCX结果差异,分析2组膈肌功能变化情况及其与肺功能指标相关性。结果COPD组20例,男18例,女2例,年龄(68.80±8.40)岁;对照组20例,男14例,女6例,年龄(45.50±13.20)岁。2组性别、身高、SpO_(2)和合并症差异均无统计学意义(均P>0.05)。COPD组年龄较对照组大,有吸烟史者占比较对照组多,体质量和身体质量指数较对照组低,分别为(68.80±8.40)岁比(45.50±13.20)岁、15例(75.0%)比8例(40.0%)、(55.15±11.34)kg比(75.78±14.71)kg、(20.10±3.78)kg/m^(2)比(26.77±4.42)kg/m^(2)(t=6.66,χ^(2)=5.01,t=4.97,t=5.13,均P<0.05)。COPD组RDEmax[28.00(25.30,34.50)mm比54.2(41.0,71.2)mm]、LDEmax[(35.74±8.51)mm比(57.50±17.72)mm]、CRr[(19.92±7.12)%比(37.54±9.32)%]、CRl[(21.53±7.19)%比(40.16±10.32)%]、CRt[(20.71±6.45)%比(38.78±9.57)%]均低于对照组(Z=4.41,t=4.95,t=6.72,t=6.63,t=7.00;均P<0.05),COPD组RLAmin(19994.28±4708.42)mm^(2)比(14095.61±2837.84)mm^(2),LLAmin(17007.54±4499.63)mm^(2)比(11761.95±2881.10)mm^(2),TLAmin(37001.82±8943.23)mm^(2)比(25857.56±5618.73)mm^(2),均大于对照组(t值分别为4.80,4.39,4.72;均P<0.05),2组RLAmax、LLAmax、TLAmax差异无统计学意义(P>0.05)。Pearson相关性分析结果:RDEmax、LDEmax、CRr、CRl、CRt与用力肺活量(FVC)、用力肺活量占预计值百分比(FVC%pred)、第1秒用力呼气容积(FEV_(1))、第1秒用力呼气容积占预计值百分比(FEV_(1)%pred)、第1秒用力呼气容积占用力肺活量之比(FEV_(1)/FVC)均呈正相关(r值分别为0.69、0.51、0.78、0.65、0.66、0.70、0.56、0.75、0.67、0.64、0.65、0.52、0.79、0.76、0.80、0.70、0.62、0.80、0.76、0.76、0.69、0.58、0.81、0.78、0.80,均P<0.05),RLAmin、LLAmin、TLAmin与FVC、FVC%pred、FEV_(1)、FEV_(1)%pred、FEV_(1)/FVC均呈负相关(r值分别为-0.39、-0.47、-0.64、-0.72、-0.79、-0.36、-0.46、-0.58、-0.67、-0.74、-0.38、-0.47、-0.62、-0.71、-0.78,均P<0.05),RLAmax、LLAmax、TLAmax与FEV_(1)%pred,FEV_(1)/FVC呈负相关(r值分别为-0.43、-0.53、-0.32、-0.45、-0.39、-0.51,P<0.05)。结论COPD患者存在双侧膈肌最大移动度、肺面积变化率下降及肺最小面积增大,DCX可以有效辅助诊断COPD患者膈肌功能,动态X线胸片上述指标与肺功能具有相关性。
Objective To investigate the value of dynamic chest X-ray(DCX)in the diagnosis of diaphragm dysfunction in patients with chronic obstructive pulmonary disease(COPD).Methods This was a case-control study.Using non-random sampling method,we selected 20 patients with COPD from the first affiliated hospital of Guangzhou Medical University from March 2022 to November 2022.Meanwhile,20 healthy control subjects were recruited by age and sex matching.Using DCX examination,Right maximum diaphragm excursion(RDEmax),Left maximum diaphragm excursion(LDEmax),Right maximum lung area(RLAmax),Left maximum lung area(LLAmax),Total maximum lung area(TLAmax),Right minimum lung area(RLAmin),Left minimum lung area(LLAmin),Total minimum lung area(TLAmin),Change ratio of right lung area(CRr),Change ratio of left lung area(CRl),and Change ratio of total lung area(CRt)were detected.The DCX results between the two groups were compared,and its correlation with pulmonary function indexes was analyzed.Results There were 18 male and 2 female in the COPD group with the age of(68.80±8.40)years.There were 14 male and 6 female in the control group,with the age of(45.50±13.20)years.There was no significant difference in gender,height,SpO_(2),and complications between the two groups(all P>0.05).The subjects in COPD group were older than those in the control group([68.80±8.40]years old vs[45.50±13.20]years,t=6.66,P<0.05).The proportion of those with smoking history was higher than that in the control group(15 cases[75.0%]vs 8 cases[40.0%],χ^(2)=5.01,P<0.05).The body mass([55.15±11.34]kg vs[75.78±14.71]kg)and body mass index([20.10±3.78]kg/m^(2)vs[26.77±4.42]kg/m^(2))of the COPD group were lower than those of the control group(t=4.97,t=5.13 respectively,both P<0.05).RDEmax,LDEmax,CRr,CRl,and CRt in COPD group were(28.00[25.30,34.50])mm,(35.74±8.51)mm,(19.92±7.12)%,(21.53±7.19)%,and(20.71±6.45)%,respectively,which were significantly lower than those in control group(Z=4.41,t=4.95,t=6.72,t=6.63,t=7.00;all P<0.05).RLAmin,LLAmin,and TLAmin in COPD group were(19994.28±4708.42)mm^(2),(17007.54±4499.63)mm^(2),(37001.82±8943.23)mm^(2),respectively,which were significantly larger than those of the control group(t values were 4.80,4.39,4.72;all P<0.05).There was no significant difference in the RLAmax,LLAmax,and TLAmax between the two groups.Pearson correlation analysis showed that there was a positive correlation between RDEmax,LDEmax,CRr,CRl,CRt and FVC,FVC%pred,FEV_(1),FEV_(1)%pred,FEV_(1)/FVC(r values were 0.69,0.51,0.78,0.65,0.66,0.70,0.56,0.75,0.67,0.64,0.65,0.52,0.79,0.76,0.80,0.70,0.62,0.80,0.76,0.76,0.69,0.58,0.81,0.78 and 0.80,respectively,all P<0.05).RLAmin,LLAmin,and TLAmin were negatively correlated with FVC,FVC%,FEV_(1),FEV_(1)%,and FEV_(1)/FVC(r values were-0.39,-0.47,-0.64,-0.72,-0.79,-0.36,-0.46,-0.58,-0.67,-0.74,-0.38,-0.47,-0.62,-0.71,and-0.78,respectively,all P<0.05).RLAmax,LLAmax,and TLAmax were negatively correlated with FEV_(1)%and FEV_(1)/FVC(r values were-0.43,-0.53,-0.32,-0.45,-0.39,and-0.51,respectively,all P<0.05).Conclusions In COPD patients,the maximum mobility of bilateral diaphragm decreased,the change rate of lung area decreased,and the minimum lung area increased.Dynamic chest x-ray can effectively assist in the diagnosis of diaphragm function in COPD,and these indexes have a good correlation with lung function.
作者
王冠理
何嘉豪
江倩
夏梓洋
陈琼珠
宋玉全
姚漪婷
李娟
杨佳诺
陈舒敏
任妮
王涛
马冉
刘春丽
Wang Guanli;He Jiahao;Jiang Qian;Xia Ziyang;Chen Qiongzhu;Song Yuquan;Yao Yiting;Li Juan;Yang Jianuo;Chen Shumin;Ren Ni;Wang Tao;Ma Ran;Liu Chunli(Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Disease,National Clinical Research Center for Respiratory Diseases,Guangzhou 510120,China;The First Affiliated Hospital of Guangzhou Medical University,Department of Radiology,Guangzhou 510120,China)
出处
《国际呼吸杂志》
2024年第4期405-412,共8页
International Journal of Respiration
基金
呼吸疾病国家重点实验室自主课题项目(SKLRD-Z-202313)
广东省自然科学基金-面上项目(2023A1515010443)
广州市科学技术局市校(院)联合资助项目(202201020401)。
关键词
肺疾病
慢性阻塞性
膈肌功能障碍
动态胸部X线片
肺功能检查
Lung disease,chronic obstructive
Diaphragm dysfunction
Dynamic chest x-ray
Pulmonary function test
作者简介
通信作者:刘春丽,Email:chunli@gird.cn。
