Zhang Tianjie, Liu Yan, Wang Mengmei, He Miao, Yu Min, Li Yi, Song Ye
Department of Ultrasonography, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, 201318, People's Republic of China.
Department of Respiratory Diseases, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jul 29;20:2629-2638. doi: 10.2147/COPD.S527119. eCollection 2025.
Chronic obstructive pulmonary disease (COPD) patients often exhibit diaphragmatic dysfunction which can be effectively assessed using ultrasonography. This study aims to evaluate diaphragmatic function in COPD patients through multimodal ultrasound imaging and to identify key parameters.
This study consecutively enrolled 75 COPD patients and 75 healthy subjects. Measurements of diaphragm contraction, motion-related parameters and tissue Doppler imaging (TDI) parameters were conducted and recorded. Clinically relevant data were collected. Baseline demographics, spirometry results, and ultrasound data were compared between COPD patients and healthy subjects. Receiver Operating Characteristic (ROC) curve was constructed to evaluate the diagnostic value of diaphragmatic ultrasound parameters for COPD patients.
Diaphragm at the end of tidal inspiration (DT_insp), diaphragm thickening fraction (DTF), diaphragmatic excursion during deep breathing (DE_DB) were significantly lower in COPD patients than in healthy subjects, conversely diaphragmatic excursion during quiet breathing (DE_QB), diaphragmatic contraction velocity during quiet breathing (DCV_QB), peak contraction velocity(PCV), peak relaxation velocity (PRV), velocity-time integral (VTI) were higher in COPD patients than in healthy subjects. DT_insp, DTF, DE_DB values decreased as COPD severity increased, conversely, DE_QB, DCV_QB, PCV, PRV and VTI exhibited an upward trend with COPD severity. DTF was positively correlated with FEV1 predicted (r=0.713, P=0.000), DE_QB (r=-0.740 and -0.889), PCV (r=-0.609 and -0.778), PRV (r=-0.686 and -0.857) were negatively correlated with FEV1/FVC and FEV1 predicted (P=0.000). Meanwhile, DE_QB, DCV_QB, PCV and PRV exhibited superior performance in predicting COPD, with AUC values of 0.906, 0.833, 0.859 and 0.833, respectively. DE_QB exhibited 81.33% sensitivity, while DTF, DE_QB, DE_DB, PCV and PRV showed high specificity (98.67%, 90.67%, 96.00%, 97.33% and 100%, respectively).
Multimodal ultrasound imaging offers a sensitive approach for detecting diaphragmatic dysfunction in COPD patients. Diaphragm ultrasound parameters correlate with pulmonary function and COPD severity, indicating that these parameters can provide valuable insights into disease progression and management.
慢性阻塞性肺疾病（COPD）患者常表现出膈肌功能障碍，超声检查可有效评估该功能障碍。本研究旨在通过多模态超声成像评估COPD患者的膈肌功能，并确定关键参数。
本研究连续纳入75例COPD患者和75例健康受试者。进行并记录膈肌收缩、运动相关参数及组织多普勒成像（TDI）参数的测量。收集临床相关数据。比较COPD患者与健康受试者的基线人口统计学特征、肺功能检查结果及超声数据。构建受试者操作特征（ROC）曲线，以评估膈肌超声参数对COPD患者的诊断价值。
COPD患者潮气末吸气时膈肌（DT_insp）、膈肌增厚率（DTF）、深呼吸时膈肌移动度（DE_DB）显著低于健康受试者，相反，COPD患者静息呼吸时膈肌移动度（DE_QB）、静息呼吸时膈肌收缩速度（DCV_QB）、峰值收缩速度（PCV）、峰值舒张速度（PRV）、速度时间积分（VTI）高于健康受试者。随着COPD严重程度增加，DT_insp、DTF、DE_DB值降低，相反，DE_QB、DCV_QB、PCV、PRV和VTI随COPD严重程度呈上升趋势。DTF与预测的第一秒用力呼气容积（FEV1）呈正相关（r = 0.713，P = 0.000），DE_QB（r = -0.740和-0.889）、PCV（r = -0.609和-0.778）、PRV（r = -0.686和-0.857）与FEV1/用力肺活量（FVC）及预测的FEV1呈负相关（P = 0.000）。同时，DE_QB、DCV_QB、PCV和PRV在预测COPD方面表现优异，AUC值分别为0.906、0.833、0.859和0.833。DE_QB的敏感度为81.33%，而DTF、DE_QB、DE_DB、PCV和PRV的特异度较高（分别为98.67%、90.67%、96.00%、97.33%和100%）。
多模态超声成像为检测COPD患者的膈肌功能障碍提供了一种敏感方法。膈肌超声参数与肺功能及COPD严重程度相关，表明这些参数可为疾病进展和管理提供有价值的见解。
