The utility of the diaphragm ultrasound in patients with COPD

Research Project

Project/Area Number	17K18089
Research Category	Grant-in-Aid for Young Scientists (B)
Allocation Type	Multi-year Fund
Research Field	General internal medicine(including psychosomatic medicine) Respiratory organ internal medicine
Research Institution	Kyorin University
Principal Investigator	Mikura Sunao 杏林大学, 医学部, 助教 (90791723)
Project Period (FY)	2017-04-01 – 2022-03-31
Project Status	Completed (Fiscal Year 2021)
Budget Amount *help	¥4,290,000 (Direct Cost: ¥3,300,000、Indirect Cost: ¥990,000) Fiscal Year 2019: ¥1,300,000 (Direct Cost: ¥1,000,000、Indirect Cost: ¥300,000) Fiscal Year 2018: ¥1,430,000 (Direct Cost: ¥1,100,000、Indirect Cost: ¥330,000) Fiscal Year 2017: ¥1,560,000 (Direct Cost: ¥1,200,000、Indirect Cost: ¥360,000)
Keywords	COPD / 横隔膜超音波 / 身体所見 / 診断研究 / 閉塞性換気障害 / 重症度 / 横断研究 / COPDの異常な身体所見の総得点は重症度と相関 / 横隔膜超音波検査は重症度と相関 / 第61回呼吸器学会学術講演会 / COPD stage Ⅲ、Ⅳ期の診断 / 吸気時横隔膜壁厚 / １４例の解析 / 症例集積の準備段階 / 慢性閉塞性肺疾患 / 超音波 / 横隔膜
Outline of Final Research Achievements	A total of 25 patients were assessed (median age, 75 (interquartile range (IQR)) 74-77) years; FEV1 44.6 (IQR 35-56.3) % predicted). The reference standard was GOLD COPD stages and %FEV1, and index tests were total abnormal physical signs (TAPS) or the parameters of diaphragm ultrasound, thickness at tidal inspiration (Tdi-inspiration), thickness at tidal expiration (Tdi-expiration), and the fraction of these (Δtdi%). The AUCs for the three diaphragm parameters were Tdi at quiet inspiration, 0.63 (95% CI, 0.43-0.82); Tdi at quiet expiration, 0.61 (95% CI, 0.39-0.79); Tdi%, 0.49 (95% CI, 0.28-0.69). The AUC for the TAPS was 0.930 (95% C.I. 0.74-0.99). TAPS correlated with %FEV1 (r = -0.81; p < 0.05) significantly, while the parameters of diaphragm ultrasound were not.
Academic Significance and Societal Importance of the Research Achievements	健常者とCOPD罹患者の鑑別を目的とした研究では, 横隔膜超音波の有用性が他の探索的研究で示されている. また, COPD内での評価も他国で行った論文も出版され, 本研究と結果は類似していた. 身体所見については, 今まで総得点の診断性能を感度特異度という形で報告したものはなかったため, 今後のより妥当性の高い研究へとつながる可能性がある.