超声测量膈肌运动诊断慢性阻塞性肺疾病

目的 探讨M型超声测量膈肌头尾向运动幅度与运动时间变化诊断慢性阻塞性肺疾病（COPD）的价值。方法 运用M型超声观察68例稳定期COPD患者（COPD组）和68名健康志愿者（对照组）膈肌头尾向运动幅度与运动时间，比较两组间平静呼吸与深呼吸时膈肌运动幅度与运动时间，分析膈肌运动幅度与肺功能的相关性，采用ROC曲线判断M型超声诊断COPD的效能。结果 平静呼吸时，COPD组双侧膈肌运动幅度大于对照组；深呼吸时，对照组双侧膈肌运动幅度大于COPD组；平静呼吸和深呼吸时，对照组右侧的膈肌运动时间均大于COPD组（P均<0.05）。深呼吸时，膈肌运动幅度与第1秒用力呼气容积（FEV1）、FEV1/用力肺活量均呈正相关（P均<0.05）。平静呼吸和深呼吸时，膈肌运动幅度诊断COPD的ROC曲线下面积（AUC）为0.823、0.858；膈肌运动时间诊断COPD的AUC分别为0.620、0.678。结论 M型超声可通过判断膈肌运动情况快捷地评估膈肌功能，可辅助诊断COPD。

Ultrasound in detection of diaphragmatic motion in diagnosis of chronic obstructive pulmonary disease

Objective To explore diagnostic value of diaphragmatic movement amplitude and time from head to tail measured with M-mode ultrasonography in diagnosis of chronic obstructive pulmonary disease (COPD).Methods Totally 68 patients with stable COPD (COPD group) and 68 healthy volunteers (control group) were examined with M-mode ultrasonography. Diaphragmatic movement amplitude and time from head to tail were recorded. The amplitude and time of diaphragmatic muscle between calm breathing and deep breathing were compared. The correlation between diaphragm motion amplitude and pulmonary function was analyzed. ROC curve was used to observe the efficacy of M-mode ultrasound in diagnosis of COPD.Results At calm breathing, the amplitudes of bilateral diaphragm movement in COPD group were greater than those in control group. At deep breathing, the amplitudes of bilateral diaphragm movement in control group were greater than those in COPD group. The right diaphragmatic movement time of control group was longer than that of COPD group at both calm and deep breathing (all P<0.05). During deep breathing, the amplitude of diaphragm motion was positively correlated with forced expiratory volume in one second (FEV1) and FEV1/forced vital capacity (all P<0.05). In calm and deep breathing, the area under the ROC curve (AUC) of diaphragmatic motion in the diagnosis of COPD was 0.823 and 0.858, and AUC of diaphragmatic movement time was 0.620 and 0.678, respectively.Conclusion Using M-mode ultrasonography can quickly assess diaphragmatic function by judging diaphragm motion, therefore being helpful to diagnosis of COPD.