剪切波弹性成像测量膈肌硬度评估慢性阻塞性肺疾病严重程度的临床价值

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ABSTRACTObjectiveTo measure the diaphragm stifnessbyshear wave elastography（SWE），and to investigate the clinical valuein assessingtheseveritychronicobstructive pulmonarydisease（COPD）.MethodsSixty-eight patients with COPD in our hospital wereselected and divided into mild-to-moderate group（41 cases）and severe group（27cases）based on the pulmonaryfunction grading criteria Global Initiativefor COPD.Pulmonaryfunction testing device was apliedto measure thepulmonary function indicators，including forced expiratory volume in the first second（ FEV1 ）and forced vital capacity（FVC）. The ratio FEV1 to FVC and the percentage FEV1 in the predicted value（FEV % pred）were calculated.Diaphragm thicknessattheendquiet inspiration，forced inspiration，quietexpirationandforcedexpiration（TDI，TDImax，TDE， TDEmax）were measuredbyhigh-frequencyultrasound，ndthediaphragm thickening rate（DTF）wascalculated.SWE was used to measure the Dsweat theend quiet expiration，andthe diferences in above parameters between thetwo groupswere compared.Correlationsbetween diaphragmaticultrasound parametersand pulmonary function indicatorswereanalyzed. Receiveroperating characteristic （ROC）curve was drawn to analyze the diagnosticeficacy ultrasound parameters in predicting severe COPD.ResultsTheFev%pred，FVC，FEV/FVC，DImax，TDE，TDEmaxandDTFinthesevere groupwere lowerthanthoseinthemild-to-moderategroup，hileDswewashigherthanthatinthemild-to-moderategroups，withstatistialy significant differences（all P<0.05 ）.There was no significant difference in TDI between the two groups.Correlation analysis showed hatTDImaxandDTwere positivelycorrelatedwithFEV%pred，FVC，FEV/FVC，whileTDE，TDEmaxandDswewere negativelycorrelatedwithFEV，%pred，FVC，FEV，/FVC（all P <0.05）.ROC curve analysis showed that the cut-f value DTF was1.O8，achieving the area under the curve（AUC） 0.789（ 95% confidence interval： O.682～0.895），with a sensitivity （204号 77.8% and specificity70.7%for predicting severe COPD.Thecut-f value Dswe was 27.04 kPa，achievingan AUC0.896 （ 95% confidence interval：0.820～0.973），which was higher than thatDTF，witha statisticallysignificant difference（ P <0.05）. The corresponding sensitivity and specificity were 85.2% and 80.5% ，respectively.Conclusion Dswe measured by SWE can assess theseverityCOPD，which hasacertainclinical value.

KEYWORDSShearwave elastography； Chronic obstructive pulmonary disease； Severity； Diaphragm function;Pulmonary function

慢性阻塞性肺疾病（chronicobstructivepulmonarydisease，COPD）是以持续性气流受限为特征的呼吸系统疾病，具有高患病率及高致死率的临床特征[1]，早期评估其严重程度对优化治疗策略及改善患者预后至关重要[2]。（剩余7716字）