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

摘要： 背景　慢性阻塞性肺疾病（COPD）患者常存在包括膈肌在内的全身骨骼肌营养不良和萎缩。膈肌疲劳是此类患者病情进展的重要病理生理机制之一，但应用超声联合肺功能评估膈肌功能却鲜见报道。目的　分析不同程度COPD患者膈肌移动度情况，及其与肺功能水平的相关性。方法　2018年3月—2019年1月采用便利抽样法选择鞍钢集团公司总医院就诊的COPD患者81例作为研究对象（COPD组），按COPD分级标准分为轻、中、重度三组，另选取鞍钢集团公司总医院肺功能室做检查的健康体检者30例作为对照组，分别行肺功能检查、超声测量平静呼吸时相膈肌移动度（FRC）及用力呼吸时相膈肌移动度（TLC），采用改良版英国医学研究会呼吸困难量表（mMRC）评估呼吸困难，记录患者的身高、体质量、体质指数（BMI）、mMRC评分、第1秒用力呼气末容积占预计值百分比（FEV1%pred）、用力肺活量占预计值百分比（FVC%pred）、第1秒用力呼气末容积占用力肺活量百分比（FEV1/FVC）、FRC、TLC、不同呼吸时相下膈肌移动度的差值（TLC-FRC）、吸气量占预计值百分比（IC%pred）、最大通气量占预计值百分比（MVV%pred）、残气量/肺总量占预计值百分比（RV/TLC%pred）等指标，并比较各组间的差异。采用Pearson相关性分析探讨膈肌移动度与研究变量间的相关性，采用多元线性回归分析探讨膈肌移动度的影响因素。结果　COPD组身高、体质量、mMRC评分高于对照组，FEV1%pred、FVC%pred、FEV1/FVC低于对照组（P<0.05）。四组间FRC、TLC、TLC-FRC比较，差异均有统计学意义（P<0.05）。重度组FRC高于对照组、轻度组、中度组，TLC、TLC-FRC低于对照组、轻度组、中度组（P<0.05）；中度组FRC高于对照组，TLC、TLC-FRC低于对照组、轻度组（P<0.05）；轻度组TLC-FRC低于对照组（P<0.05）。相关性分析结果，COPD组膈肌移动度与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）呈正相关，与mMRC评分（r=-0.615，P<0.001）、RV/TLC%pred（r=-0.350，P<0.001）呈负相关。多元线性回归分析结果显示，FEV1%pred〔β=0.728，95%CI（0.027，0.042），P=0.001〕是膈肌移动度的影响因素。结论　COPD患者膈肌移动度可以用超声来评价，而膈肌移动度的大小与肺功能水平呈正相关。

关键词: 肺疾病,慢性阻塞性, 膈肌, 超声, 肺功能