Tager I B, Segal M R, Speizer F E, Weiss S T
VA Medical Center, Department of Medicine, San Francisco, CA 94121.
Am Rev Respir Dis. 1988 Oct;138(4):837-49. doi: 10.1164/ajrccm/138.4.837.
Epidemiologic investigations into the natural history of airway obstructive disease have focused on both the growth and decline of lung function measurements. Although a general picture has emerged as to overall patterns of growth/decline, uncertainty remains with regard to important details of these patterns. Pulmonary function data from subjects aged 5 yr and and older who participated in any or all of the first 10 annual surveys of the East Boston population-based study have been used to investigate patterns of growth and decline of lung function derived from maximal forced expiratory maneuvers. At each annual survey, subjects completed a standardized respiratory illness and smoking questionnaire and provided forced expiratory volume-time curves from which forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were derived. A nonparametric curve smoothing method was used to provide an overall summary of growth and decline of each measure of function. Asymptomatic, nonsmoking males demonstrated a pattern of growth of FEV1 that included a prolonged plateau phase or period of slow, continued growth from ages 23 to 35 yr. Decline in lung function began after this period and occurred in two phases that averaged about -20 and -30 ml/yr. In contrast, no plateau phase was observed for male current smokers. In these smokers, decline in FEV1 began in the early part of the third decade at a rate only slightly greater than that observed for nonsmokers (-25 to -30 ml/yr). Similar patterns and rates of decline were observed for females, although the presence of a plateau phase was less clearly discernible. These data suggest that a major effect of cigarette smoking on lung function decline involves the premature onset of a "normal" rate of decline in function and, to a lesser extent, more rapid rates of decline later in life and that the pattern and magnitude of decline is similar in males and females.
对气道阻塞性疾病自然史的流行病学调查主要集中在肺功能测量值的增长和下降方面。尽管已经出现了关于增长/下降总体模式的大致情况，但这些模式的重要细节仍存在不确定性。来自东波士顿基于人群研究的前10次年度调查中，5岁及以上参与了任何一次或全部调查的受试者的肺功能数据，已被用于研究最大用力呼气动作所产生的肺功能增长和下降模式。在每次年度调查中，受试者完成一份标准化的呼吸道疾病和吸烟问卷，并提供用力呼气容积-时间曲线，从中得出用力肺活量（FVC）和一秒用力呼气容积（FEV1）。采用非参数曲线平滑方法来总体概括每种功能测量值的增长和下降情况。无症状、不吸烟的男性表现出FEV1的增长模式，其中包括一个延长的平台期，即从23岁到35岁有一个缓慢持续增长的时期。在此之后肺功能开始下降，且分为两个阶段，平均每年下降约20和30毫升。相比之下，现吸烟男性未观察到平台期。在这些吸烟者中，FEV1在第三个十年早期就开始下降，下降速度仅略高于不吸烟者（每年-25至-30毫升）。女性也观察到类似的下降模式和速度，尽管平台期的存在不太明显。这些数据表明，吸烟对肺功能下降的主要影响包括使功能“正常”下降速度提前出现，在较小程度上还包括使后期生命中的下降速度更快，而且男性和女性的下降模式及幅度相似。
