老年人肺活量测定时的限制性肺功能障碍与死亡率

Restrictive pulmonary dysfunction at spirometry and mortality in the elderly.

作者信息

Scarlata Simone, Pedone Claudio, Fimognari Filippo L, Bellia Vincenzo, Forastiere Francesco, Incalzi Raffaele Antonelli

机构信息

Chair of Geriatrics, University Campus Bio-Medico, Via dei Compositori, 130 - 00128 Rome, Italy.

出版信息

Respir Med. 2008 Sep;102(9):1349-54. doi: 10.1016/j.rmed.2008.02.021. Epub 2008 Jul 2.

DOI:10.1016/j.rmed.2008.02.021

PMID:18599282

Abstract

OBJECTIVES

To evaluate the association between pulmonary restriction and mortality in the elderly, taking into account potential confounders not considered in the past (disability, cognitive dysfunction, diabetes, and visceral obesity).

DESIGN

Longitudinal study.

SETTING

Community-based.

PARTICIPANTS

Twelve hundred sixty-five patients (51.9% men) aged 65-97 years old from the Salute Respiratoria nell'Anziano (SaRA) Italian multicentric study.

MEASUREMENTS

Participants were divided in 4 groups: normal spirometry (NS): FEV1/FVC > or = 70%, FVC > or = 80% of predicted; restrictive ventilatory pattern (RVP): FEV1/FVC > or = 70%, FVC<80%; obstructive ventilatory pattern (OVP): FEV1/FVC < 70%, FVC > or = 80%, and mixed ventilatory pattern (MVP): FEV1/FVC < 70%, FVC < 80%. We calculated the association between restriction and mortality corrected for potential confounders using a multivariable Cox regression model.

RESULTS

We found a prevalence of RVP, OVP and MVP of 10.9%, 25.4%, and 17.3%, respectively. Compared to people with normal spirometric pattern, disability (19.6% vs. 10.1%), poor physical performance (35.4% vs. 22.3%), cognitive impairment (21.0% vs. 11.5%), increased waist circumference (62.1% and 26.8%), and kyphoscoliosis (56.8 and 13.5%) were more prevalent in the RVP group. After correction for potential confounders, RVP was associated with increased mortality (HR: 1.89; 95% CI: 1.15-3.11), as well as OVP (HR: 2.33; 95% CI: 1.58-3.11) and MVP (HR: 2.60; 95% CI: 1.74-3.93). Other factors associated with mortality were disability (HR: 1.92; 95% CI: 1.35-2.72), poor physical performance (HR: 1.37; 95% CI: 1.01-1.85), cognitive impairment (HR: 1.55; 95% CI: 1.06-2.27), depression (HR: 1.57; 95% CI: 1.16-2.13) and diagnosis of stroke (HR: 1.90; 95% CI: 1.18-3.05).

CONCLUSIONS

RVP is associated with higher mortality in the elderly and, thus, deserves the same attention paid to an obstructive pattern. However, mechanisms mediating this association need to be clarified.

摘要

目的

考虑过去未纳入的潜在混杂因素（残疾、认知功能障碍、糖尿病和内脏肥胖），评估老年人肺功能受限与死亡率之间的关联。

设计

纵向研究。

背景

基于社区。

参与者

来自意大利“老年呼吸健康（SaRA）”多中心研究的1265例年龄在65 - 97岁之间的患者（51.9%为男性）。

测量指标

参与者被分为4组：肺量计测量正常（NS）：第一秒用力呼气容积/用力肺活量（FEV1/FVC）≥70%，用力肺活量（FVC）≥预测值的80%；限制性通气模式（RVP）：FEV1/FVC≥70%，FVC < 80%；阻塞性通气模式（OVP）：FEV1/FVC < 70%，FVC≥80%，以及混合性通气模式（MVP）：FEV1/FVC < 70%，FVC < 80%。我们使用多变量Cox回归模型计算校正潜在混杂因素后肺功能受限与死亡率之间的关联。