脑瘫儿童超声衍生的膈肌运动学和形态计量学参数：一项比较横断面研究

摘要(中文译文)

本研究旨在应用超声评估脑性瘫痪（CP）患儿与典型发育对照儿童相比的膈肌力学及形态学特征。通过量化位移、收缩/舒张速度及厚度等参数，我们旨在区分原发性呼吸肌损伤与人体测量学及临床混杂因素，从而为针对性管理提供依据。这项比较性横断面研究共纳入102名参与者：51名痉挛型CP患儿（GMFCS I-V级）和51名年龄、性别匹配的健康对照儿童。采用膈肌超声评估位移、厚度及收缩/舒张速度。应用多因素线性回归模型，校正年龄、性别、体重以及临床混杂因素（用药情况、既往手术史和肺部疾病史），以确定与CP的独立相关性。在未校正分析中，CP患儿较对照组表现出呼气位移显著降低（p = 0.00）、呼吸时间缩短（p = 0.00），同时吸气厚度增加（p = 0.03）和收缩速度增快（p = 0.01）。在校正人口学、人体测量学及临床混杂因素后，吸气相关差异不再显著，提示其反映的是与体型相关的效应。相反，呼气位移降低（p = 0.03）和呼气时间缩短（p = 0.01）仍与CP独立相关，尤其在非行走参与者（GMFCS IV-V级）中更为明显。CP患儿膈肌力学和形态学的大多数观察差异可归因于较低的体重及相关混杂因素。然而，呼气位移和呼气时间的持续性降低独立于人体测量学及临床混杂因素，表明呼气相是CP患儿呼吸功能损伤的一个关键且独特的标志。在该人群中，膈肌超声的临床解读需要严格校正，以避免诊断误判。• 呼吸功能障碍是脑性瘫痪（CP）患儿发病的主要原因之一，由神经肌肉损伤和胸壁力学改变所驱动。• 膈肌超声是评估呼吸肌功能的可靠、无创工具，但其在CP患儿中的应用仍然有限。• 在校正人口学、人体测量学及临床混杂因素后，大多数膈肌参数与CP无独立相关性。• 呼气功能障碍（表现为呼气位移降低和呼气时间缩短）作为一个独特特征浮现，提示腹肌功能受损可能是CP患儿呼吸功能障碍中一个此前未被充分认识到的机制。

Abstract

The purpose was. to evaluate diaphragmatic mechanics and morphometry using ultrasound in children with cerebral palsy (CP) compared to typically developing controls. By quantifying parameters such as excursion, contraction/relaxation velocity, and thickness, we aimed to distinguish primary respiratory muscle impairment from anthropometric and clinical confounders to inform targeted management. This comparative cross-sectional study included 102 participants: 51 children with spastic CP (GMFCS levels I-V) and 51 age- and sex-matched healthy controls. Diaphragmatic ultrasound was used to assess excursion, thickness and contraction/relaxation velocity. Multivariate linear regression models, adjusted for age, sex, and weight, as well as clinical confounders (medication use, prior surgeries, and history of pulmonary disease), were applied to determine independent associations with CP. In the unadjusted analysis, children with CP showed significantly reduced expiratory excursion (p = 0.00) and shorter respiratory times (p = 0.00) than controls, together with greater inspiratory thickness (p = 0.03) and contraction velocity (p = 0.01). After adjustment for demographic, anthropometric, and clinical confounders, the inspiratory differences were no longer significant, indicating that they reflected body size-related effects. In contrast, reduced expiratory excursion (p = 0.03) and shorter expiratory time (p = 0.01) remained independently associated with CP, particularly in nonambulatory participants (GMFCS IV-V). Most observed differences in diaphragmatic mechanics and morphometry in children with CP are attributable to lower weight and related confounders. However, the persistent reduction in expiratory excursion and expiratory time, independent of anthropometric and clinical confounders, identifies the expiratory phase as a critical and distinct marker of respiratory impairment in children with CP. Clinical interpretation of diaphragmatic ultrasound in this population requires rigorous adjustment to avoid diagnostic misinterpretation. • Respiratory dysfunction is a major contributor to morbidity in children with cerebral palsy (CP), driven by neuromuscular impairment and altered chest wall mechanics. • Diaphragm ultrasound is a reliable, noninvasive tool for assessing respiratory muscle function, although its application in children with CP remains limited. • After adjustment for demographic, anthropometric, and clinical confounders, most diaphragmatic parameters were not independently associated with CP. • Expiratory dysfunction (characterized by reduced expiratory excursion and shortened expiratory time) emerged as a distinct feature, suggesting that impaired abdominal muscle function may represent a previously underrecognized mechanism of respiratory dysfunction in children with CP.

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