Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort study
Lifetime spirometry patterns of obstruction and restriction, and their risk factors and outcomes: a prospective cohort study
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DOI：
10.1016/s2213-2600(22)00364-2
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发表时间：
2023-02-28
影响因子：
76.2
通讯作者：
Perret, Jennifer L.
中科院分区：
文献类型：
--
作者：
Dharmage, Shyamali C.;Bui, Dinh S.;Perret, Jennifer L.
背景：越来越多的证据表明，慢性阻塞性肺疾病（COPD）可由多种不利的肺功能途径引起，包括那些源于儿童时期肺功能不良的途径，因此人们对终生肺功能轨迹的兴趣日益增加。据我们所知，以前没有研究同时调查过阻塞性和限制性的生活模式，同时考虑到它们之间的潜在重叠。我们的目的是研究FEV1/强迫肺活量（FVC）比率、FVC及其组合的终生轨迹，将这些联合轨迹组与静态肺体积和气体传输测量相关联，并研究这些联合轨迹组的危险因素和后果。方法利用塔斯马尼亚纵向健康研究（n=2422）中7岁、13岁、18岁、45岁、50岁和53岁时肺活量测定的z分数，通过基于组的轨迹模型确定了6个FEV1/FVC比率轨迹和5个FVC轨迹。根据FEV1/FVC比率和FVC的轨迹是低（即儿童期或成年期低）还是正常，确定了四种终生肺活量测定障碍或限制模式，并与静态肺容量和气体传输进行了比较。调查了这些类型的儿童和成年期的特征和发病率。发现四种终生肺活量测量模式的患病率为：仅FEV1/FVC比低，标记为仅梗阻，25中心点8%；只有低植被覆盖度，标记为限制性，10中心点5%；低FEV1/FVC和低FVC，标记为混合，3中心点5%；既不低FEV1/FVC，也不低FVC，标记为参考，60中心点2%。53岁时COPD患病率最高的是混合模式（84例中有31例[37%]），其次是单纯阻塞性模式（626例中有135例[22%]）。具有混合模式的个体在父母哮喘、儿童呼吸系统疾病、成人哮喘和抑郁症方面的患病率也最高。仅限气模式个体的总肺活量和剩余肺活量较低，儿童体重不足、成人肥胖、糖尿病、心血管疾病、高血压和阻塞性睡眠呼吸暂停的患病率最高。据我们所知，这是第一个同时使用客观数据驱动技术和独特的生命历程肺活量测定法（FEV1/FVC比率和FVC）来表征梗阻和受限终生表型的研究。混合模式和单纯阻塞性模式表明这些患者可能从早期COPD干预中获益。那些只有限制性模式的人有证据表明真正的肺限制，并且在中年时多重发病的风险增加。
Background Interest in lifetime lung function trajectories has increased in the context of emerging evidence that chronic obstructive pulmonary disease (COPD) can arise from multiple disadvantaged lung function pathways, including those that stem from poor lung function in childhood. To our knowledge, no previous study has investigated both obstructive and restrictive lifetime patterns concurrently, while accounting for potential overlaps between them. We aimed to investigate lifetime trajectories of the FEV1/forced vital capacity (FVC) ratio, FVC, and their combinations, relate these combined trajectory groups to static lung volume and gas transfer measurements, and investigate both risk factors for and consequences of these combined trajectory groups. Methods Using z scores from spirometry measured at ages 7, 13, 18, 45, 50, and 53 years in the Tasmanian Longitudinal Health Study (n=2422), we identified six FEV1/FVC ratio trajectories and five FVC trajectories via group-based trajectory modelling. Based on whether trajectories of the FEV1/FVC ratio and FVC were low (ie, low from childhood or adulthood) or normal, four patterns of lifetime spirometry obstruction or restriction were identified and compared against static lung volumes and gas transfer. Childhood and adulthood characteristics and morbidities of these patterns were investigated. Findings The prevalence of the four lifetime spirometry patterns was as follows: low FEV1/FVC ratio only, labelled as obstructive-only, 25 center dot 8%; low FVC only, labelled as restrictive-only, 10 center dot 5%; both low FEV1/FVC ratio and low FVC, labelled as mixed, 3 center dot 5%; and neither low FEV1/FVC ratio nor low FVC, labelled as reference, 60 center dot 2%. The prevalence of COPD at age 53 years was highest in the mixed pattern (31 [37%] of 84 individuals) followed by the obstructive-only pattern (135 [22%] of 626 individuals). Individuals with the mixed pattern also had the highest prevalence of parental asthma, childhood respiratory illnesses, adult asthma, and depression. Individuals with the restrictive-only pattern had lower total lung capacity and residual volume, and had the highest prevalence of childhood underweight, adult obesity, diabetes, cardiovascular conditions, hypertension, and obstructive sleep apnoea. Interpretation To our knowledge, this is the first study to characterise lifetime phenotypes of obstruction and restriction simultaneously using objective data-driven techniques and unique life course spirometry measures of FEV1/FVC ratio and FVC from childhood to middle age. Mixed and obstructive-only patterns indicate those who might benefit from early COPD interventions. Those with the restrictive-only pattern had evidence of true lung restriction and were at increased risk of multimorbidity by middle age.