摘要
背景 20%～30%的保留比率的肺量计异常(PRISm)会发展为慢性阻塞性肺疾病(COPD),但我国目前对其特征的研究非常有限.目的 分析PRISm的影响因素,探讨PRISm人群与COPD患者在危险因素分布特征上的差异.方法 本研究依托上海市社区健康管理工作开展,选取 2022 年 7 月—2023 年 6 月在上海市普陀区 11 个社区参加COPD早期筛查的 60 岁以上社区老年人进行问卷调查和肺功能检测.共 876 例参加了本次调查,剔除 141 例问卷信息不完整或肺功能检测质量不合格的对象,最终得到研究对象 735 例.以吸入支气管舒张剂后的肺功能对研究对象进行分组:COPD组[第 1 秒用力呼气容积(FEV1)/用力肺活量(FVC)<70%],PRISm组[FEV1 与预计值之比(FEV1%Pred)<80%且FEV1/FVC≥70%],肺功能正常组(FEV1%Pred≥80%且FEV1/FVC≥70%).以肺功能正常组为对照,通过多因素Logistic回归分析探讨COPD、PRISm的相关因素.结果 COPD组 157 例(21.36%),PRISm组 113 例(15.37%),肺功能正常组 465 例(63.27%).三组慢阻肺自我筛查问卷(COPD-SQ)总分比较,COPD组评分最高[(20.46±4.53)分],PRISm组次之[(19.04±4.41)分],肺功能正常组评分最低[(18.03±4.26)分],差异有统计学意义(P<0.001).单因素分析结果显示:PRISm组男性比例、吸烟量、存在反复发作的喘息比例、有慢性支气管炎比例、有高血压比例高于肺功能正常组(P<0.05);但与COPD组相比,PRISm组男性比例、吸烟量、存在运动后喘息或咳嗽症状比例、有肺气肿比例均较低,但高血压患病率却较高(P<0.05).多因素Logistic回归分析显示:年龄增大、性别为男性、吸烟量增加、身体活动不足、存在反复发作的喘息、存在运动后喘息或咳嗽、有COPD或支气管哮喘家族史、有支气管哮喘或肺气肿是COPD的影响因素(P<0.05);而吸烟量增加、身体活动不足、存在反复发作的喘息、有慢性支气管炎和有高血压是PRISm的影响因素(P<0.05).结论 PRISm是介于COPD和肺功能正常间的一种高危状态,其在年龄、吸烟、身体活动、症状及疾病史分布上与COPD类似,但COPD-SQ评分及Logistic回归模型对于肺功能状态的预测效果显著低于COPD.高血压仅在PRISm中为独立相关因素,提示PRISm人群可能存在独立于COPD的心血管疾病风险.而PRISm人群特征在疾病进展中的作用仍待进一步验证.
Abstract
Background 20%-30%of individuals with Preserved Ratio Impaired Spirometry(PRISm)will develop chronic obstructive pulmonary disease(COPD).However studies on characteristics of PRISm in China remain limited.Objective To analyze factors associated with PRISm,and to explore the difference in the distribution of risk factors between individuals with PRISm and COPD.Methods This study was conducted as part of health management in Shanghai communities.Elderly individuals over 60 years old from 11 communities in Putuo District,Shanghai,who participated COPD screening from July 2022 to June 2023,were surveyed and underwent lung function tests.A total of 876 participants were initially included,but 141 were excluded due to incomplete questionnaire information or poor lung function test quality,resulting in 735 valid subjects.According to the"Guidelines for Graded Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease"and GOLD 2024,participants were classified into three subgroups based on post-bronchodilator lung function:COPD group(FEV1/FVC<70%),PRISm group(FEV1%Pred<80%and FEV1/FVC≥70%),and normal lung function group.Multivariate Logistic regression analyses were conducted to identify factors associated with COPD and PRISm,using normal lung function as the control.Results A total of 735 individuals aged 60～81 were included.COPD and PRISm were observed in 157(21.36%)and 113(15.37%)participants,respectively.COPD-SQ scores were highest in the COPD group(20.46±4.53),followed by the PRISm group(19.04±4.41)and lowest in the normal lung function group(18.03±4.26)with statistically significant differences(P<0.001).Univariate analysis showed that the PRISm group had higher proportions of males,smokers,individuals with frequent wheezing,chronic bronchitis and hypertension compared to the normal lung function group(P<0.05).Compared to COPD patients,the PRISm group had lower proportions of males,smokers,individuals with symptoms of wheezing or coughing after exercise,and those with a history of emphysema,but a higher prevalence of hypertension(P<0.05).Multivariable Logistic regression analyses revealed that increasing age,male gender,higher smoking levels,insufficient physical activity,frequent wheezing,wheezing or coughing after exercise,family history of COPD or bronchial asthma,and history of bronchial asthma or emphysema were associated with COPD(P<0.05).In contrast,higher smoking levels,insufficient physical activity,frequent wheezing,chronic bronchitis,and hypertension were associated with PRISm(P<0.05).Conclusion PRISm is a high-risk state between COPD and normal lung function,sharing similar associated factors with COPD such as age,smoking states,physical activity,symptoms and comorbidities.However,the COPD-SQ score and the predictive performance of multivariable logistic regression model for lung function status were significantly lower for PRISm compared to COPD.Hypertension was an independent associated factor for PRISm,but not for COPD,suggesting a potential risk of cardiovascular disease independent of COPD.Further research is warranted to verify the role of PRISm characteristics in disease progression.
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