摘要
目的应用剪切波弹性成像(SWE)测量膈肌硬度(Dswe),探讨其评估慢性阻塞性肺疾病(COPD)严重程度中的临床价值。方法选取我院68例COPD患者,根据COPD全球倡议肺功能分级标准将其分为轻中度组41例和重度组27例,应用肺功能仪测量肺功能指标,包括第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC),并计算二者比值(FEV_(1)/FVC)及FEV_(1)占预计值的百分比(FEV_(1)%pred);高频超声测量平静吸气末、用力吸气末、平静呼气末、用力呼气末膈肌厚度(TDI、TDImax、TDE、TDEmax),并计算膈肌增厚率(DTF);SWE测量平静呼气末Dswe,比较两组上述参数的差异;分析膈肌超声参数与肺功能指标的相关性。绘制受试者工作特征(ROC)曲线分析膈肌超声参数预测重度COPD的诊断效能。结果重度组FEV_(1)%pred、FVC和FEV_(1)/FVC、TDImax、TDE、TDEmax、DTF均低于轻中度组,Dswe高于轻中度组(均P<0.05);两组TDI比较差异无统计学意义。相关性分析显示,TDImax、DTF与FEV_(1)%pred、FVC、FEV_(1)/FVC均呈正相关,TDE、TDEmax、Dswe与FEV_(1)%pred、FVC、FEV_(1)/FVC均呈负相关(均P<0.05)。ROC曲线分析显示,当DTF截断值为1.08时其预测重度COPD的曲线下面积(AUC)为0.789(95%可信区间:0.682~0.895),灵敏度为77.8%,特异度为70.7%。当Dswe截断值为27.04 kPa时其预测重度COPD的AUC为0.896(95%可信区间:0.820~0.973),高于DTF的AUC,差异有统计学意义(P<0.05);其对应的灵敏度为85.2%,特异度为80.5%。结论SWE所测Dswe可用于评估COPD严重程度,具有一定的临床价值。
Objective To measure the diaphragm stiffness by shear wave elastography(SWE),and to investigate the clinical value in assessing the severity of chronic obstructive pulmonary disease(COPD).Methods Sixty-eight patients with COPD in our hospital were selected and divided into mild-to-moderate group(41 cases)and severe group(27 cases)based on the pulmonary function grading criteria of Global Initiative for COPD.Pulmonary function testing device was applied to measure the pulmonary function indicators,including forced expiratory volume in the first second(FEV_(1))and forced vital capacity(FVC).The ratio of FEV_(1) to FVC and the percentage of FEV_(1) in the predicted value(FEV_(1)%pred)were calculated.Diaphragm thickness at the end of quiet inspiration,forced inspiration,quiet expiration and forced expiration(TDI,TDImax,TDE,TDEmax)were measured by high-frequency ultrasound,and the diaphragm thickening rate(DTF)was calculated.SWE was used to measure the Dswe at the end of quiet expiration,and the differences in above parameters between the two groups were compared.Correlations between diaphragmatic ultrasound parameters and pulmonary function indicators were analyzed.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ultrasound parameters in predicting severe COPD.Results The Fev1%pred,FVC,FEV_(1)/FVC,TDImax,TDE,TDEmax and DTF in the severe group were lower than those in the mild-to-moderate group,while Dswe was higher than that in the mild-to-moderate groups,with statistically significant differences(all P<0.05).There was no significant difference in TDI between the two groups.Correlation analysis showed that TDImax and DTF were positively correlated with FEV_(1)%pred,FVC,FEV_(1)/FVC,while TDE,TDEmax and Dswe were negatively correlated with FEV_(1)%pred,FVC,FEV_(1)/FVC(all P<0.05).ROC curve analysis showed that the cut-off value of DTF was 1.08,achieving the area under the curve(AUC)of 0.789(95%confidence interval:0.682~0.895),with a sensitivity of 77.8%and specificity of 70.7%for predicting severe COPD.The cut-off value of Dswe was 27.04 kPa,achieving an AUC of 0.896(95%confidence interval:0.820~0.973),which was higher than that of DTF,with a statistically significant difference(P<0.05).The corresponding sensitivity and specificity were 85.2%and 80.5%,respectively.Conclusion Dswe measured by SWE can assess the severity of COPD,which has a certain clinical value.
作者
陈昭杰
张小靖
刘芳欣
CHEN Zhaojie;ZHANG Xiaojing;LIU Fangxin(Department of Ultrasound,Bozhou Hospital Affiliated to Anhui Medical University,the People’s Hospital of Bozhou,Bozhou 236800,China;Graduate School of Bengbu Medical University,Bengbu 233000,China)
出处
《临床超声医学杂志》
2025年第8期688-693,共6页
Journal of Clinical Ultrasound in Medicine
基金
亳州市人民医院院级科研项目(by2023034)。
关键词
剪切波弹性成像
慢性阻塞性肺疾病
严重程度
膈肌功能
肺功能
Shear wave elastography
Chronic obstructive pulmonary disease
Severity
Diaphragm function
Pulmonary function
