肺量计数据库中比值保留的肺量计功能障碍。
Preserved Ratio Impaired Spirometry in a Spirometry Database.
机构信息
Department of Internal Medicine, Division of General Internal Medicine, University of Iowa, Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa.
Division of Pulmonary, Critical Care and Occupational Medicine, University of Iowa Hospital and Clinics, Iowa City, Iowa.
出版信息
Respir Care. 2021 Jan;66(1):58-65. doi: 10.4187/respcare.07712. Epub 2020 Sep 1.
BACKGROUND
Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV or FVC in the setting of preserved FEV/FVC. Previous studies have estimated the prevalence of PRISm to be 7-12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm.
METHODS
We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm.
RESULTS
We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45-60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV (odds ratio 1.51, 95% CI 1.42-1.60), body mass index (odds ratio 1.52, 95% CI 1.39-1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54-7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46-0.65) with PRISm.
CONCLUSIONS
In a spirometry database at an academic medical center, the PRISm prevalence was 17-24%, which is higher than previously reported.
背景
肺量测定结果可得出正常气流、气流阻塞或保留比值受损的肺量测定（PRISm）的诊断，定义为在 FEV/FVC 保留的情况下 FEV 或 FVC 降低。先前的研究估计 PRISm 的患病率为 7-12%。我们的目的是在肺量测定数据库中检查 PRISm 的患病率，并确定与 PRISm 相关的因素。
方法
我们对 21870 次肺量测定进行了回顾性分析；由于数据缺失或年龄、身高或体重极端，1616 次被排除在外。我们计算了预支气管扩张剂和后支气管扩张剂肺功能测试中 PRISm 的患病率。随后，我们按各种年龄、种族、体重指数和诊断类别，以及性别和吸烟者与非吸烟者计算了 PRISm 的患病率。最后，在 FEV<正常下限的队列亚组中，我们进行了多变量逻辑回归分析，以确定与 PRISm 相关的因素。
结果
我们确定了 18059 次预支气管扩张剂肺量测定，其中 22.3%的肺量测定结果为 PRISm 诊断。在排除了有多次肺功能测试的受试者的早期肺功能测试后（预支气管扩张剂为 20.7%，后支气管扩张剂为 24.3%），以及当我们将分析仅限于符合美国胸科学会标准的预支气管扩张剂肺量测定时（预支气管扩张剂为 20.6%），这种患病率在支气管扩张剂后肺量测定中保持稳定（17.7%）。45-60 岁的受试者（24.4%）和男性（23.7%）的 PRISm 患病率高于女性（17.9%）。患病率随体重指数而升高，并且对于有肺限制性疾病转诊诊断的患者更高（50%）。种族和吸烟者与非吸烟者之间的 PRISm 患病率相似。在多变量分析中，较高的预测 FEV%（比值比 1.51，95%CI 1.42-1.60）、体重指数（比值比 1.52，95%CI 1.39-1.68）和限制性肺疾病（比值比 4.32，95%CI 2.54-7.57）与 PRISm 的诊断相关。吸烟与 PRISm 呈负相关（比值比 0.55，95%CI 0.46-0.65）。
结论
在学术医疗中心的肺量测定数据库中，PRISm 的患病率为 17-24%，高于先前的报告。
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