Kronik obstrüktif akciğer hastalığı alevlenmesinde solunum kaslarının sonografik olarak incelenmesi ve alevlenmenin klinik şiddeti ile ilişkisinin değerlendirilmesi
Küçük Resim Yok
Tarih
2020
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Bolu Abant İzzet Baysal Üniversitesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Bu çalışmadaki esas amacımız, KOAH alevlenme hastalarında, solunum kaslarının artmış yükünün dolaylı göstergesi olarak parasternal interkostal ve diyafram solunum kaslarındaki kalınlaşma fraksiyonunu sonografik olarak incelemek ve alevlenmenin klinik şiddeti ile ilişkisinin saptamaktır. Çalışmamız Abant İzzet Baysal Üniversitesi Göğüs Hastalıkları ve Radyoloji ABD'de 01.09.2019-24.03.2020 tarihleri arasında prospektif olarak gerçekleştirildi. 50 yaş üstünde olan, GOLD kriterlerine göre bilinen KOAH tanısı olan ve hastaneye KOAH alevlenme şikâyeti ile başvuran toplam 159 hasta sonografik olarak değerlendirildi. Hastaların 63'ünün hafif, 63'ünün orta ve 33'ünün ağır şiddette alevlenme kliniği vardı. Parasternal interkostal ve pektoralis majör kas kalınlaşma fraksiyonlarının, orta ve ağır alevlenmelerde hafif alevlenmelere kıyasla anlamlı derecede daha yüksek, diyafram kas kalınlaşma fraksiyonunun ise anlamlı derecede daha düşük olduğu bulunmuştur (p<0.001). Ağır ve orta alevlenme gruplarında ise parasternal interkostal ve pektoralis majör kas kalınlaşma fraksiyonlarının ağır alevlenmelerde orta alevlenmelere göre anlamlı derecede daha yüksek olduğu (p<0.001) saptanmış olup diyafram kas kalınlaşma fraksiyonunda ise bu iki grup arasında anlamlı farklılık saptanmamıştır. Ayrıca KOAH alevlenmenin klinik şiddeti ile solunum kas kalınlıkları ve FEV1 arasında anlamlı derecede negatif korelasyon olduğu gösterilmiştir (p<0.001). Son 1 yıl içerisindeki alevlenme sayısıyla ise FEV1 (%beklenen) ve kas kalınlıkları arasında anlamlı derecede negatif korelasyon saptanmıştır (p<0.001). Sonuç olarak alevlenmenin klinik şiddeti arttıkça parasternal interkostal ve pektoralis majör kaslarındaki kalınlaşma fraksiyonları artış göstermekte, ancak diyaframda ise bunun tam tersi olarak azalma göstermektedir. Ultrasonografi ile solunum kaslarının değerlendirilmesi, iyonlaştırıcı radyasyon riski olmadan, KOAH alevlenmenin değerlendirmesinde, ağır alevlenme geçirme riski olan KOAH hasta grubunu karakterize edilmesinde faydalı bilgiler sağlayabilir ve hastanın takibinde güvenilir ve tekrarlanabilir bir biyobelirteç olabilir. Ayrıca KOAH hastalarında solunum kaslarının fonksiyonunu ve tedavilere yanıtı değerlendirmek için yeni fırsatlar yaratabilir. Anahtar Kelimeler: Solunum kas ultrasonografisi, KOAH alevlenme, parasternal interkostal ve diyafram kaslarında kalınlaşma fraksiyonu
In this study, our aim is to examine the thickening fraction of the parasternal intercostal and diaphragm respiratory muscles as an indirect indicator of the increased load of respiratory muscles in patients with COPD exacerbation and to determine the its relationship between clinical severity of exacerbation. Our study was conducted prospectively between 01.09.2019-24.03.2020 in Abant Izzet Baysal University Chest Diseases and Radiology Departments. A total of 159 patients who were over 50 years of age, with a diagnosis of COPD known according to GOLD criteria, and with a complaint of COPD exacerbation to the hospital, were evaluated sonographically. Of the patients, 63 had mild, 63 had moderate and 33 had severe exacerbation. Parasternal intercostal and pectoralis majör muscle thickening fractions were found to be significantly higher in moderate and severe exacerbations compared to mild exacerbations, while the diaphragm muscle thickening fraction was significantly lower (p<0.001). In the severe and moderate exacerbation groups, the parasternal intercostal and pectoralis majör muscle thickening fractions were found to be significantly higher in severe exacerbations than in the moderate exacerbations (p <0.001), but however, there was no significant difference in diaphragm muscle thickening fraction between these two groups. In addition, there was a significant negative correlation between the clinical severity of COPD exacerbation and respiratory muscle thickness and FEV1 (%expected) (p <0.001). A significant negative correlation was found between the number of exacerbations in the last 1 year and FEV1 (% expected) and muscle thickness (p <0.001). As a result, as the clinical severity of exacerbation increases, the thickening fractions in the parasternal intercostal and pectoralis majör muscles increase, but in the diaphragm, on the contrary, it decreases. Assessment of respiratory muscles by ultrasonography, without the risk of ionizing radiation, can provide useful information in the assessment of COPD exacerbation, characterizing the group of COPD patients at risk of experiencing severe exacerbation, and it can be a reliable and reproducible biomarker in patient follow-up. It can also create new opportunities to evaluate the function of respiratory muscles and response to treatments in COPD patients. Keywords: Respiratory muscle ultrasonography, COPD exacerbation, thickening fraction in parasternal intercostal and diaphragm muscles
In this study, our aim is to examine the thickening fraction of the parasternal intercostal and diaphragm respiratory muscles as an indirect indicator of the increased load of respiratory muscles in patients with COPD exacerbation and to determine the its relationship between clinical severity of exacerbation. Our study was conducted prospectively between 01.09.2019-24.03.2020 in Abant Izzet Baysal University Chest Diseases and Radiology Departments. A total of 159 patients who were over 50 years of age, with a diagnosis of COPD known according to GOLD criteria, and with a complaint of COPD exacerbation to the hospital, were evaluated sonographically. Of the patients, 63 had mild, 63 had moderate and 33 had severe exacerbation. Parasternal intercostal and pectoralis majör muscle thickening fractions were found to be significantly higher in moderate and severe exacerbations compared to mild exacerbations, while the diaphragm muscle thickening fraction was significantly lower (p<0.001). In the severe and moderate exacerbation groups, the parasternal intercostal and pectoralis majör muscle thickening fractions were found to be significantly higher in severe exacerbations than in the moderate exacerbations (p <0.001), but however, there was no significant difference in diaphragm muscle thickening fraction between these two groups. In addition, there was a significant negative correlation between the clinical severity of COPD exacerbation and respiratory muscle thickness and FEV1 (%expected) (p <0.001). A significant negative correlation was found between the number of exacerbations in the last 1 year and FEV1 (% expected) and muscle thickness (p <0.001). As a result, as the clinical severity of exacerbation increases, the thickening fractions in the parasternal intercostal and pectoralis majör muscles increase, but in the diaphragm, on the contrary, it decreases. Assessment of respiratory muscles by ultrasonography, without the risk of ionizing radiation, can provide useful information in the assessment of COPD exacerbation, characterizing the group of COPD patients at risk of experiencing severe exacerbation, and it can be a reliable and reproducible biomarker in patient follow-up. It can also create new opportunities to evaluate the function of respiratory muscles and response to treatments in COPD patients. Keywords: Respiratory muscle ultrasonography, COPD exacerbation, thickening fraction in parasternal intercostal and diaphragm muscles
Açıklama
Tıp Fakültesi, Radyoloji Ana Bilim Dalı
Anahtar Kelimeler
Radyoloji ve Nükleer Tıp, Radiology and Nuclear Medicine
