Department of Ultrasonography, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou City, China.
Department of Respiratory and Critical Care Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.
J Ultrasound Med. 2021 Dec;40(12):2655-2663. doi: 10.1002/jum.15655. Epub 2021 Feb 21.
Skeletal muscle dysfunction is one of the most common comorbidities in chronic obstructive pulmonary disease (COPD). The occurrence of respiratory failure in COPD is common and leads to the patient's death. The diaphragm is the most important muscle in the respiratory system and plays a key role in the onset of respiratory failure. This study explores the feasibility of ultrasound shear wave elastography (SWE) to measure diaphragmatic stiffness and evaluates its changes in COPD patients.
In total, 77 participants (43 patients with stable COPD and 34 healthy controls) were enrolled. All subjects underwent complete diaphragmatic ultrasound SWE measurements and pulmonary function tests. The diaphragmatic stiffness was indicated via diaphragmatic shear wave velocity (SWV) at functional residual capacity (FRC). A trained operator performed the ultrasound SWE examinations of the first 15 healthy controls thrice to assess the reliability of diaphragmatic SWE.
A good to excellent reliability was found in diaphragmatic SWV at FRC (ICC = 0.93, 95%CI 0.82-0.98). As compared to the control group, the diaphragmatic SWV at FRC was considerably high in the COPD group (median 2.5 m/s versus 2.1 m/s, P = .008). Diaphragmatic SWV at FRC was linked to forced expiratory volume in one second (r = -0.30, P = .009), forced vital capacity (r = -0.33, P = .003), modified Medical Research Council score (r = 0.30, P = .001), and COPD assessment test score (r = 0.48, P < .001).
Ultrasound SWE may be employed as an effective tool for quantitative evaluation of diaphragm stiffness and can help in personalized management of COPD, such as treatment guidance and follow-up monitoring.
骨骼肌功能障碍是慢性阻塞性肺疾病（COPD）最常见的合并症之一。COPD 患者常发生呼吸衰竭，并导致患者死亡。膈肌是呼吸系统中最重要的肌肉，在呼吸衰竭的发生中起着关键作用。本研究旨在探讨超声剪切波弹性成像（SWE）测量膈肌硬度的可行性，并评估其在 COPD 患者中的变化。
共纳入 77 名参与者（43 名稳定期 COPD 患者和 34 名健康对照者）。所有受试者均接受完整的膈肌超声 SWE 测量和肺功能检查。膈肌硬度通过功能残气量（FRC）下的膈肌剪切波速度（SWV）表示。一名经过培训的操作人员对前 15 名健康对照者的膈肌超声 SWE 检查进行了 3 次重复测量，以评估膈肌 SWE 的可靠性。
FRC 下膈肌 SWV 的可靠性良好至极好（ICC=0.93，95%CI 0.82-0.98）。与对照组相比，COPD 组 FRC 下的膈肌 SWV 明显较高（中位数 2.5 m/s 比 2.1 m/s，P=0.008）。FRC 下的膈肌 SWV 与一秒用力呼气容积（r=-0.30，P=0.009）、用力肺活量（r=-0.33，P=0.003）、改良医学研究理事会评分（r=0.30，P=0.001）和 COPD 评估测试评分（r=0.48，P<0.001）相关。
超声 SWE 可作为定量评估膈肌硬度的有效工具，并有助于 COPD 的个体化管理，如治疗指导和随访监测。
