FEV1: More than a Measurement of Lung Function, A Biomarker of Health.
FEV1: More than a Measurement of Lung Function, A Biomarker of Health.
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FEV1：不仅仅是肺功能的测量，更是健康的生物标志物。
DOI：
10.1164/rccm.202401-0090ed
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发表时间：
2024
影响因子：
24.7
通讯作者：
Labaki,WassimW
中科院分区：
文献类型：
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作者：
Labaki,WassimW
长期以来，临床医生一直使用肺功能测定法（包括FEV 1和FVC）来帮助诊断、监测和评估肺部疾病。最近，已经确定了生命过程中的各种肺功能轨迹（1）。在成年早期无法达到正常峰值FEV 1已被认为是以后生活中慢性阻塞性肺疾病的危险因素（2）。此外，成年早期FEV 1较低与早期肺部和非肺部合并症以及过早全因死亡的风险较高相关（3）。然而，FEV 1在正常范围内的变化如何影响长期临床结果的研究很少。1229-1237）旨在了解FEV 1在正常范围内（定义为使用种族中立的全球肺功能倡议参考方程预测> 80%）和两个队列的全因20年死亡率，纽约市消防局（FDNY;平均年龄，38.7岁）和第三次全国健康和营养检查调查（NHANES;平均年龄，37.7岁）（4）。与FEV 1> 120%预测值的受试者相比，在调整年龄、性别、种族/民族、吸烟史和工作分配（仅在FDNY）后，两个队列中肺功能类别逐渐降低的受试者的死亡风险越来越高。值得注意的是，FEV 1 80-89%预测值的患者在随后20年内死亡的可能性约为2倍，FDNY和NHANES的风险比（HR）分别为1.90（95%置信区间[CI]，1.36-2.65）和2.40（95% CI，1.51-3.80）。当作为连续变量进行分析时，FDNY（HR，0.85; 95%CI，0.80-0.91）和NHANES（HR，0.77; 95%CI，0.71-0.84）中FEV1%预测值在正常范围内每增加10%，死亡率就降低。在两个队列中，死亡率的HR在FEV 1 80%和110%预测值之间持续下降，对FEV 1的影响减弱。110%预测正如预期，两个队列中FEV 1和FVC高度相关。对FEV 1绝对值（以升为单位）、使用Hankinson参考方程预测的FEV1%以及增加FEV 1，80%预测值的参与者进行敏感性分析，均得到类似的结果。值得注意的是，两个队列中与麻醉相关的死亡占所有死亡的5%。这项研究揭示了一个重要的临床问题，它有几个优点。它包括两个大型独立队列，一个是职业人群（FDNY），另一个更能代表美国普通人群（NHANES），这支持了其研究结果的普遍性。此外，各种敏感性分析证实了不同结果的一致性。
Clinicians have long used spirometry measurements, including FEV1 and FVC, to help with the diagnosis, monitoring, and prognostication of lung diseases. More recently, various lung function trajectories over the life course have been identified (1). The inability to reach normal peak FEV1 in early adulthood has been recognized as a risk factor for chronic obstructive pulmonary disease later in life (2). In addition, a low FEV1 in early adulthood has been associated with a higher risk of early pulmonary and nonpulmonary comorbidities and premature all-cause mortality (3). However, how the variation of FEV1 within the normal range affects long-term clinical outcomes has been little investigated.In this issue of the Journal, Cannon and colleagues (pp. 1229–1237) aimed to understand the association between FEV1 in the normal range (defined as> 80% predicted using race-neutral Global Lung Function Initiative reference equations) and all-cause 20-year mortality in two cohorts, the Fire Department of the City of New York (FDNY; mean age, 38.7 yr) and the third National Health and Nutrition Examination Survey (NHANES; mean age, 37.7 yr)(4). Compared with participants with FEV1> 120% predicted, those in progressively lower lung function categories had an increasingly higher risk of death in both cohorts after adjustment for age, sex, race/ethnicity, smoking history, and work assignment (in FDNY only). Notably, those with FEV1 80–89% predicted were about twice as likely to die in the subsequent 20 years, with hazard ratios (HRs) of 1.90 (95% confidence interval [CI], 1.36–2.65) and 2.40 (95% CI, 1.51–3.80) in FDNY and NHANES, respectively. When analyzed as a continuous variable, each 10% increment in FEV1% predicted within the normal range was associated with lower mortality in FDNY (HR, 0.85; 95% CI, 0.80–0.91) and NHANES (HR, 0.77; 95% CI, 0.71–0.84). In both cohorts, the HR for mortality continuously decreased between FEV1 80% and 110% predicted, with attenuation of effect for FEV1. 110% predicted. As expected, FEV1 and FVC were highly correlated in both cohorts. Sensitivity analyses with absolute FEV1 in liters, FEV1% predicted using Hankinson reference equations, and the addition of participants with FEV1, 80% predicted all yielded similar results. Of note, respiratory-related deaths accounted for, 5% of all deaths in both cohorts. This study, which sheds much-needed light on an important clinical question, has several strengths. It included two large independent cohorts, one occupational (FDNY) and the other more representative of the general US population (NHANES), which supports the generalizability of its findings. Furthermore, the various sensitivity analyses confirm the consistency of results across different