Dag Nurullah, Berktas Haci Bayram, Uslu Aysun Gunduz, Burulday Veysel
Department of Radiology, Faculty of Medicine, Inonu University, Malatya, Türkiye.
Department of Nephrology, Faculty of Medicine, Inonu University, Malatya, Türkiye.
BMC Med Imaging. 2025 Sep 26;25(1):380. doi: 10.1186/s12880-025-01932-6.
This study aimed to quantitatively and noninvasively assess diaphragmatic alterations in patients with end-stage renal disease undergoing hemodialysis (HD) or peritoneal dialysis (PD) using ultrasonography (US) and shear wave elastography (SWE).
This prospective cross-sectional study included 69 dialysis patients (HD, = 37; PD, = 32) and 60 demographically matched healthy controls. Right hemidiaphragm was evaluated using greyscale US and SWE through the 8th–10th intercostal spaces in the mid-axillary line. Thickness and stiffness were measured at end-expiration and peak inspiration phases. Clinical data, laboratory parameters, and dialysis-related metrics were recorded. Comparative and correlational analyses were performed using appropriate statistical methods.
At peak inspiration, the measurements were 2.24 ± 0.25 mm and 25.61 ± 6.15 kPa for the HD group, 2.53 ± 0.23 mm and 32.79 ± 5.31 kPa for the PD group, and 2.86 ± 0.29 mm and 47.68 ± 6.67 kPa for the control group. Significant differences were observed between the groups for both parameters ( < 0.001). At end expiration, diaphragm thickness and stiffness were 1.69 ± 0.20 mm/19.46 ± 4.37 kPa, 1.75 ± 0.19 mm/22.62 ± 4.84 kPa, and 2.00 ± 0.19 mm/33.26 ± 4.62 kPa in the HD, PD, and control groups, respectively. There were significant differences between the groups ( < 0.05). ROC analysis indicated excellent diagnostic performance of these parameters for distinguishing dialysis patients from controls (AUC 0.806–0.987). Furthermore, diaphragm parameters correlated significantly with dialysis duration, adequacy, comorbidity, and serum albumin levels.
Diaphragm thickness and stiffness are reduced in dialysis patients, especially those on hemodialysis. US and SWE may serve as early imaging biomarkers for respiratory sarcopenia.
本研究旨在使用超声（US）和剪切波弹性成像（SWE）对接受血液透析（HD）或腹膜透析（PD）的终末期肾病患者的膈肌改变进行定量和无创评估。
这项前瞻性横断面研究纳入了69例透析患者（HD组37例；PD组32例）和60例人口统计学匹配的健康对照者。通过腋中线第8至第10肋间间隙，使用灰阶超声和SWE评估右半膈肌。在呼气末和吸气峰值期测量膈肌厚度和硬度。记录临床资料、实验室参数和透析相关指标。采用适当的统计方法进行比较和相关性分析。
在吸气峰值时，HD组的测量值分别为2.24±0.25mm和25.61±6.15kPa，PD组为2.53±0.23mm和32.79±5.31kPa，对照组为2.86±0.29mm和47.68±6.67kPa。两组间这两个参数均存在显著差异（<0.001）。在呼气末，HD组、PD组和对照组的膈肌厚度和硬度分别为1.69±0.20mm/19.46±4.37kPa、1.75±0.19mm/22.62±4.84kPa和2.00±0.19mm/33.26±4.62kPa。组间存在显著差异（<0.05）。ROC分析表明这些参数在区分透析患者和对照组方面具有出色的诊断性能（AUC为0.806 - 0.987）。此外，膈肌参数与透析时间、充分性、合并症和血清白蛋白水平显著相关。
透析患者，尤其是血液透析患者的膈肌厚度和硬度降低。超声和剪切波弹性成像可作为呼吸性肌肉减少症的早期影像学生物标志物。
