Decreased and slower diaphragmatic motion during forced breathing in severe COPD patients: Time-resolved quantitative analysis using dynamic chest radiography with a flat panel detector system
Decreased and slower diaphragmatic motion during forced breathing in severe COPD patients: Time-resolved quantitative analysis using dynamic chest radiography with a flat panel detector system
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DOI：
10.1016/j.ejrad.2018.12.023
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发表时间：
2019-03-01
影响因子：
3.3
通讯作者：
Kudoh, Shoji
中科院分区：
文献类型：
--
作者：
Hida, Tomoyuki;Yamada, Yoshitake;Kudoh, Shoji
目的：应用动态胸片时间分辨定量分析方法评价慢性阻塞性肺疾病（COPD）患者强迫呼吸时的膈肌运动，并探讨其特征及其与正常人的差异。材料和方法：本研究包括31例COPD患者和31例年龄、性别、身高、体重正常的对照者，均在强迫呼吸时使用动态胸片进行胸片检查。COPD患者根据全球慢性阻塞性肺疾病倡议（GOLD）的标准进行分类（GOLD 1, n = 3; GOLD 2, n = 12; GOLD 3, n = 13; GOLD 4, n = 3）。我们测量了每个参与者横膈膜的位移和峰值运动速度。我们比较了GOLD 1/2、GOLD 3/4组和正常受试者的结果，并调查了数据与受试者人口统计学或肺功能之间的关系。结果：GOLD 3/4组与正常组相比（右，39.8 +/- 15.3 mm vs. 52.7 +/- 15.1 mm, P = 0.030；左，43.7 +/- 14.0 mm vs. 56.9 +/- 15.5 mm, P = 0.017；平均+/-标准差）和GOLD 1/2组（右，39.8 +/- 15.3 mm vs. 54.4 +/- 16.7 mm, P = 0.036；左，43.7 +/- 14.0 mm vs. 60.5 +/- 13.9 mm, P = 0.008）双侧膈肌偏移明显减少。GOLD 1/2组吸气期左膈肌运动峰值速度低于正常组（24.5 +/- 8.0 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.038）， GOLD 3/4组吸气期左膈肌运动峰值速度低于正常组（25.6 +/- 6.8 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.067）。横膈膜位移与VC、%VC和FEV1相关，而运动峰值速度与肺功能测试无显著相关性。结论：动态胸片对膈肌的时间分辨定量分析显示COPD组与正常受试者在强迫呼吸时膈肌运动的差异。用力呼吸时，GOLD 3/4组膈肌位移明显低于GOLD 1/2组和正常人。
Objective: To assess the diaphragmatic motion in chronic obstructive pulmonary disease (COPD) patients during forced breathing by time-resolved quantitative analysis using dynamic chest radiography and to demonstrate the characteristics and the difference from that in normal subjects.Materials and methods: Thirty-one COPD patients and a matched control of 31 normal subjects on age, sex, height, and weight, who underwent chest radiographs during forced breathing using dynamic chest radiography, were included in this study. COPD patients were classified based on the criteria of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) (GOLD 1, n = 3; GOLD 2, n = 12; GOLD 3, n = 13; GOLD 4, n = 3). We measured excursions and peak motion speeds of the diaphragms for each participant. We compared the results among GOLD 1/2, GOLD 3/4 groups and normal subjects and investigated associations between the data, and participants' demographics, or pulmonary function.Results: The excursions of bilateral diaphragms were significantly decreased in the GOLD 3/4 group relative to normal subjects (right, 39.8 +/- 15.3 mm vs. 52.7 +/- 15.1 mm, P = 0.030; left, 43.7 +/- 14.0 mm vs. 56.9 +/- 15.5 mm, P = 0.017; mean +/- standard deviation) and the GOLD 1/2 group (right, 39.8 +/- 15.3 mm vs. 54.4 +/- 16.7 mm, P = 0.036; left, 43.7 +/- 14.0 mm vs. 60.5 +/- 13.9 mm, P = 0.008). The peak motion speeds of the left diaphragm in the inspiratory phase were slower in the GOLD 1/2 group than in normal subjects (24.5 +/- 8.0 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.038), and in the GOLD 3/4 group than in normal subjects (25.6 +/- 6.8 mm/s vs. 33.6 +/- 14.0 mm/s, P = 0.067). The excursions of the diaphragms showed correlation with VC, %VC, and FEV1, while the peak motion speeds showed no significant correlation with pulmonary function tests.Conclusions: Time-resolved quantitative analysis of diaphragms with dynamic chest radiography indicated differences in diaphragmatic motion between COPD groups and normal subjects during forced breathing. The excursions of the diaphragms during forced breathing were significantly lower in the GOLD 3/4 group than those in the GOLD 1/2 group and normal subjects.