Objective: To study the correlation between diaphragm excursion and both the quality of life and exercise capacity in patients with chronic obstructive pulmonary disease (COPD) by ultrasound and to reveal the factors affecting diaphragm excursion. Methods: A total of 42 COPD patients who were treated in our hospital from October 2015 to March 2020 and 42 healthy volunteers (control group) were included in the present study. The participants’ height, weight, and diaphragm excursion (the amplitude of diaphragm movement during deep breathing measured by M-mode ultrasound (ΔM)), diaphragm movement time, degree of airflow obstruction (the forced expiratory volume in one second (FEV1) as a percentage of its predicted level, FEV1%pred), and exercise capacity (six-minute walk distance, 6MWD) were measured. The St. George’s Respiratory Questionnaire (SGRQ) was used to evaluate the patients’ quality of life. The correlation between the amplitude of diaphragm movement and lung function was analyzed. The receiver operating characteristics (ROC) curve was used to determine the COPD diagnosis efficacy of M-mode ultrasound, and its influencing factors were further analyzed. Results: During tidal breathing, the movement amplitudes of both hemidiaphragms in the COPD group were greater than those in the control group. During deep breathing, the movement amplitudes of both hemidiaphragms in the control group were greater than those in the COPD group. Moreover, during both tidal and deep breathing, the movement time of the right hemidiaphragm in the control group was longer than that in the COPD group (all P < 0.001). During deep breathing, the amplitude of diaphragm movement was positively correlated with FEV1 and FEV1%pred (both P < 0.001). During both tidal and deep breathing, the area under the ROC curve (AUC) for the diagnosis of COPD according to the diaphragm movement amplitude was 0.833 and 0.887, respectively, and the AUC for the diagnosis of COPD according to the diaphragm movement time was 0.625 and 0.732, respectively. The ΔM was correlated with the SGRQ score, symptom score, impact score, activity score, and 6MWD, with correlation coefficients of −0.474, −0.416, −0.432, −0.502, and 0.536, respectively. The factors affecting the ΔM were height (β=0.407, P < 0.001) and FEV1%pred (β=−0.391, P < 0.001). Conclusion: The diaphragm excursion in COPD was closely related to patients’ quality of life. Height and FEV1%pred had the greatest impact on diaphragm excursion. The lower the diaphragm excursion of the patient, the worse their quality of life and the lower their exercise capacity.

中文翻译：

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慢性阻塞性肺疾病患者膈肌偏移与生活质量和运动能力的相关性超声研究

客观的：超声研究慢性阻塞性肺疾病（COPD）患者膈肌偏移与生活质量和运动能力的相关性，揭示影响膈肌偏移的因素。方法：本研究共纳入 2015 年 10 月至 2020 年 3 月在我院接受治疗的 COPD 患者 42 例和健康志愿者 42 例（对照组）。参与者的身高、体重和横膈膜偏移（通过 M 型超声测量的深呼吸期间横膈膜运动的幅度（Δ米))、横膈膜运动时间、气流阻塞程度（一秒用力呼气量（FEV1）占其预测水平的百分比，FEV1%pred）和运动能力（六分钟步行距离，6MWD）。圣乔治呼吸问卷 (SGRQ) 用于评估患者的生活质量。分析膈肌运动幅度与肺功能的相关性。采用受试者工作特征（ROC）曲线判断M型超声诊断COPD的疗效，并进一步分析其影响因素。结果：潮式呼吸时，COPD组双侧膈肌运动幅度大于对照组。深呼吸时，对照组两侧膈肌运动幅度大于COPD组。此外，无论是潮式呼吸还是深呼吸，对照组右侧膈肌运动时间均长于 COPD 组（均磷 < 0.001)。深呼吸时，横膈膜运动幅度与 FEV1 和 FEV1%pred 呈正相关（均磷 < 0.001)。潮式呼吸和深呼吸时，根据膈肌运动幅度诊断 COPD 的 ROC 曲线下面积（AUC）分别为 0.833 和 0.887，根据膈肌运动时间诊断 COPD 的 AUC 为 0.625和 0.732，分别。这Δ米与SGRQ评分、症状评分、影响评分、活动评分和6MWD相关，相关系数分别为-0.474、-0.416、-0.432、-0.502和0.536。影响因素Δ米身高（β=0.407,磷 < 0.001) 和 FEV1%pred (β=-0.391,磷 < 0.001)。结论：COPD膈肌偏移与患者的生活质量密切相关。高度和 FEV1%pred 对横膈膜偏移的影响最大。患者的横膈膜偏移越低，他们的生活质量越差，运动能力越低。