摘要目的 观察慢阻肺患者三维重建后的膈肌形态学变化,并评价其与疾病严重程度的关系.方法 选取2010年7月至2011年4月上海东方医院门诊和住院后随访的男性患者,年龄45～80岁,分为慢阻肺组30例,其中轻度、中度和重度/极重度各10例；对照组20例.分别进行肺功能测试,在残气容积和肺总量时相进行CT扫描获得图像并用软件处理,构建三维重建两时相状态下的膈肌形态.观察慢阻肺组冠状位和矢状位膈肌总长度(C-Ldi和S-Ldi)、对合长度(C-Lap和S-Lap)、膈穹隆长度(Ldo)、膈肌总面积(Adi)、对合面积(Aap)及膈穹隆面积(Ado)等的变化,研究形态学参数变化及其与肺功能的关系.结果 慢阻肺组残气容积时相S-Ldi和S-Lap分别为(23.3±2.9) cm和(5.4±1.9) cm,显著低于对照组的(31.1±4.3) cm和(12.7±2.0) cm,差异均有统计学意义(t值分别为4.12和6.96,均P＜0.05)；矢状位较冠状位的变化更显著,以S-Lap减小为主.慢阻肺组残气容积时相Adi和Aap分别为(571±119) cm2和(270±99) cm2,显著低于对照组的(811 ±95) cm2和(471 ±61) cm2,差异均有统计学意义(t值分别为4.06和4.33,均P＜0.05),以Aap减小为主.S-Lap和Aap与肺功能的相关性良好(r值为0.577～0.787,均P＜0.05),其中Aap的相关性最强,肺总量时相仅C-Ldi和C-Lap减小(t值分别为3.08和2.80,均P＜0.05).结论 慢阻肺患者膈肌长度缩短和面积减少,深呼气末位最明显,其中对合区域是长度和面积减少的主要部分.对合区域膈肌面积可间接反映慢阻肺患者肺气肿的严重程度.

abstractsObjective To study the morphological alteration of the diaphragm with three-dimensional reconstruction in patients with chronic obstructive pulmonary disease (COPD),and to evaluate the relationship between morphological parameters and pulmonary function.Methods Subjects were consecutively recruited in Shanghai East Hospital of Tongji University from July 2010 to April 2011.They were divided into a COPD (30 males) group,including mild (n =10),moderate (n =10),and severe/ very severe (n =10),and a control group (20 males) ; with the age of the subjects ranging from 45 to 80 years old.The subjects were asked to take pulmonary function test.Each subject underwent CT scanning in residual volume (RV) and total lung capacity (TLC) phases.The imaging of CT scanning was used to reconstruct three-dimensional diaphragm with the special computer software.The length of total diaphragm (Ldi),including the part of the zone apposition (Lap) and part of the dome (Ldo) under coronal (C) and sagittal (S) were observed.The surface area of the diaphragm (Adi),surface area (Aap) of the zone of apposition and surface area (Ado) of the dome were measured as well.In addition,the relationship between morphological indexs and pulmonary function were evaluated.Results In RV phase,compared with the control,Ldi and Lap were significantly lower in COPD,S-Ldi: (23.3 ±2.9) cm vs (31.1 ±4.3) cm (t =4.12,P＜0.05); S-Lap: (5.4±1.9) cm vs (12.7±2.0) cm,(t =6.96,P＜0.05); the difference was more obvious in sagittal slices as compared to the coronal slices.The reduction of S-Ldi was more pronounced in the part of S-Lap.In RV phase,Adi and Aap were also significant lower in COPD,Adi: (571 ± 119) cm2 vs (811 ±95) cm2(t =4.06,P ＜0.05).Aap: (270 ±99) cm2 vs (471 ±61) cm2 (t =4.33,P ＜ 0.05).Aap decreased more significantly,and accounted for the most part of reduction of Adi.There was a significant positive correlation between Aap and S-Lap with pulmonary function (r =0.577-0.787,all P ＜ 0.05),especially for Aap (r =0.787).In TLC phase,only C-Ldi and C-Lap decreased significantly (t =3.08,t =2.80 respectively,all P ＜ 0.05).Conclusions The diaphragmatic length and surface area decreased in patients with COPD,which were more pronounced in the part of the zone of apposition and occurred during RV phase.The dimension of the zone of apposition could be a parameter to reflect the severity of the disease.