ASSESSMENT OF THE EFFECT OF PULMONARY REHABILITATION ON THE RESPIRATORY MUSCLES AND REGIONAL THORACIC MOTION BY USING NEW IMAGING TECHNIQUES AND MOLECULAR BIOLOGICAL METHOD IN PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD)

为评价肺康复治疗对呼吸肌和局部呼吸力学的影响，对18例COPD患者（年龄67±7[SD]岁，FEV 1 1.05±0.44 L）进行了为期6周的综合性肺康复治疗。该方案包括病人教育、物理治疗、运动训练和营养咨询。呼吸困难的显著改善（100 mm VAS 41±24至28±20 mm），生活质量（SGRQ评分47.8±12.1至39.1±15.5），TGV呼吸肌力（PImax-58 ± 16 ~-71 ± 19，PEmax 149±42 ~ 162±39 cmH_2O），6 MWD（435±63 ~ 471± 51 m）。对10例COPD患者在康复治疗前后进行动态呼吸磁共振成像（MRI）检查。采用场回波法在矢状面和冠状面采集图像，扫描时间为1 se，每周期18秒，连续48次 ...更多信息 c /图像）。10例患者接受了6周门诊治疗（n=8）或2周住院治疗（n=2）。在上肋骨架（冠状面和右矢状面）和左膈肌（左矢状面）中观察到运动显著增加（Δ = D吸气- D呼气[D：距离]）。通过视觉评分评估胸壁扩张、肋骨抬高、心尖增宽、后伸和膈肌向下移位之间的协调性，并在每个平面上获得改善。提示胸部动态MRI可提供早期疾病和康复后改善的定量评估，这是其他方法无法检测到的，它可以促进更好的生理理解。为了证实氧自由基对膈肌线粒体损伤的证据，我们检查了26例肺部疾病患者的膈肌。横膈膜的肋部在死后8小时内获得。26例膈肌DNA样本中有24例（92%）显示mtDNA缺失5 kb，与年龄无关。然而，由于在所有18例COPD患者中均未观察到外周血中mtDNA的5 kb缺失，因此无法评估肺康复对氧化应激的影响。我们计划在不久的将来使用更灵敏的PCR技术，如实时PCR或其他骨骼肌的活检标本。少

To assess the effect of pulmonary rehabilitation on the respiratory muscles and regional respiratory mechanics, the six-week comprehensive pulmonary rehabilitation program supported by an interdisciplinary team was organized and conducted in 18 patients with COPD (age 67±7[SD]years, FEVl 1.05±0.44 L). The program consists of patient education, physiotherapy, exercise training, and nutritional consultation. The significant improvements in dyspnea (100mm VAS 41±24 to 28±20 mm), quality of life (SGRQ Score 47.8±12.1 to 39.1±15.5), TGV (5.99±0.93 to 5.64±1.06 L), respiratory muscle strength (PImax -58±16 to -71±19, PE max 149±42 to 162±39 cmH_2O), 6MWD (435±63 to 471±51m) were obtained. The dynamic breathing magnetic resonance imaging (MRI) was performed in ten COPD patients with before and after the rehabilitation. The images were acquired with field echo method at sagittal and coronal planes over three slow deep respiratory cycles (18 sec / cycle, 48 sequential image, scanning time : 1se … More c / image). Ten patients had six week outpatient (n=8) or two week inpatient (n=2) program. A significant increase in motion (Δ = D inspiration - D expiration [D : distance]) was observed in the upper rib cage (coronal and right sagittal plane) and the left diaphragm (left sagittal plane). The coordination among the chest wall expansion, rib cage elevation, widening of the apex, back stretch, and downward displacement of the diaphragm was assessed by using visual score and improvement was also obtained in each plain. It is suggested that the thoracic dynamic MRI may provide quantitative assessment both in initial disorder and post rehabilitation improvement which is otherwise undetectable and it can promote better physiological understanding. To confirm the evidence of the mitochondrial damage in the diaphragm by oxygen-based free radicals, we examined the diaphragms of 26 subjects with pulmonary diseases. The costal parts of diaphragms were obtained within 8 hrs of post mortem. Twenty-four of 26 DNA samples(92%) from diaphragms showed a 5kb deletion of mtDNA regardless of age. However, the effect of pulmonary rehabilitation on oxidative stress was not able to be evaluated since a 5kb deletion of mtDNA in the peripheral blood was not observed in all 18 COPD patients. We are planning the use of more sensitive PCR techniques such as realtime PCR or the biopsied specimens of other skeletal muscles in the near future. Less