关键词: 肺疾病,慢性阻塞性, 膈肌, 超声, 肺功能

Abstract: Background　Systemic skeletal muscular（including diaphragm）dystrophy and atrophy，are common in chronic obstructive pulmonary disease（COPD）patients.Diaphragmatic fatigue is one of the important pathophysiological bases for disease progression in these patients.But the application of ultrasound combined with pulmonary function in the evaluation of diaphragm function is rarely reported.Objective　To perform a disease severity-based analysis of diaphragm mobility and its correlation with pulmonary function in COPD patients.Methods　From Ansteel Group Hospital during March 2018 to January 2019，81 COPD patients（consisting of mild，moderate and severe patients evaluated by the GOLD criteria），and 30 healthy controls undergoing examination in Pulmonary Function Examination Room were selected.Pulmonary function test was used to examine lung function related parameters.Ultrasound was carried out to measure the diaphragm mobility during quiet breathing at functional residual capacity（FRC）and during forced breathing at total lung capacity（TLC），respectively.The mMRC Dyspnoea Scale was used to assess the status of dyspnea.The height，weight，body mass index (BMI)，mMRC dyspnoea score，FEV1%pred，FVC%pred，FEV1/FVC，FRC，TLC，TLC-FRC，and inspiratory breath were recorded IC%pred，MVV%pred，RV/TLC%pred were compared.Pearson correlation analysis was used to explore the correlation between diaphragmatic mobility and research variables. Multiple linear regression analysis was used to explore the influencing factors of diaphragm mobility.Results　COPD patients had greater average height，weight，and mMRC dyspnoea score，but lower average FEV1%pred，FVC%pred and FEV1/FVC compared with the controls（P<0.05）.The diaphragm mobility in quiet breathing phase，forced breathing phase，and the difference of diaphragm mobility from FRC to TLC were significantly different among mild，moderate and severe COPD patients and controls（P<0.05）.Severe patients had greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC than mild and moderate patients and controls（P<0.05）.Moderate patients showed greater average diaphragm mobility at FRC and lower average diaphragm mobility at TLC and difference of diaphragm mobility from FRC to TLC compared with mild patients and controls（P<0.05）.Mild patients demonstrated lower average difference of diaphragm mobility from FRC to TLC compared with controls（P<0.05）.In COPD group，diaphragm mobility was positively correlated with BMI（r=0.501，P<0.001），FEV1%pred（r=0.697，P<0.001），FVC%pred（r=0.639，P<0.001），FEV1/FVC（r=0.564，P<0.001），IC%pred（r=0.438，P<0.001），MVV%pred（r=0.578，P<0.001），and negatively correlated with mMRC（r=-0.615，P<0.001）and  RV/TLC%pred（r=-0.350，P<0.001）.Multiple linear regression analysis showed that FEV1% pred〔β=0.728，95% CI（0.027，0.042），P=0.001〕was the influencing factor of diaphragm mobility.Conclusion　Diaphragm mobility in COPD patients can be assessed by ultrasound.The degree of diaphragm mobility is related to the level of pulmonary function.

Key words: Pulmonary disease, chronic obstructive；Diaphragm；Ultrasound；Pulmonary function