Bui Dinh S, Perret Jennifer L, Walters E Haydn, Lodge Caroline J, Bowatte Gayan, Hamilton Garun S, Thompson Bruce R, Frith Peter, Erbas Bircan, Thomas Paul S, Johns David P, Wood-Baker Richard, Hopper John L, Davis Peter G, Abramson Michael J, Lowe Adrian J, Dharmage Shyamali C
Centre for Epidemiology and Biostatistics, School of Population and Global health, The University of Melbourne, Melbourne, VIC, Australia.
Centre for Epidemiology and Biostatistics, School of Population and Global health, The University of Melbourne, Melbourne, VIC, Australia; School of Medicine and Menzies Institute, University of Tasmania, Hobart, TAS, Australia.
Lancet Respir Med. 2022 May;10(5):478-484. doi: 10.1016/S2213-2600(21)00508-7. Epub 2022 Feb 18.
Prematurity has been linked to reduced lung function up to age 33 years, but its long-term effects on lung function and chronic obstructive pulmonary disease (COPD) are unknown. To address this question, we investigated associations between prematurity, lung function, and COPD in the sixth decade of life using data from the Tasmanian Longitudinal Health Study (TAHS).
Data were analysed from 1445 participants in the TAHS. Lung function was measured at 53 years of age. Gestational ages were very preterm (28 weeks to <32 weeks), moderate preterm (32 weeks to <34 weeks), late preterm (34 weeks to <37 weeks) and term (≥37 weeks). Linear and logistic regression models were fitted to investigate associations of prematurity with lung function measures (FEV, forced vital capacity [FVC], FEV/FVC ratio, forced expiratory flow at 25-75% of FVC [FEF], diffusing capacity for carbon monoxide [DLCO]) and COPD (post-bronchodilator FEV/FVC less than the lower limit of normal), adjusting for sex, age, height, parental smoking during pregnancy, number of older siblings, maternal age at birth, and childhood socioeconomic status. Interactions with smoking and asthma were also investigated.
Of 3565 individuals with available data on gestational age from the TAHS cohort, 1445 (41%) participants were included in this study, 740 (51%) of whom were female. Compared with term birth, very to moderate preterm birth was significantly associated with an increased risk of COPD at age 53 years (odds ratio 2·9 [95% CI 1·1-7·7]). Very-to-moderate preterm birth was also associated with lower post-bronchodilator FEV/FVC ratio (beta-coefficient -2·9% [95% CI -4·9 to -0·81]), FEV (-190 mL [-339 to -40]), DLCO (-0·55 mmol/min/kPa [-0·97 to -0·13]), and FEF (-339 mL/s [-664 to -14]). The association between very-to-moderate preterm birth and FEV/FVC ratio was only significant among smokers (p=0·0082). Similar findings were observed for moderate preterm birth when analysed as a separate group. Compared with term birth, late preterm birth was not associated with lower FEV/FVC ratio or COPD.
This is the first study to investigate the effect of prematurity on lung function into middle-age. Data show that very-to-moderate prematurity is associated with obstructive lung function deficits including COPD well into the sixth decade of life and that this effect is compounded by personal smoking.
National Health and Medical Research Council (NHMRC) of Australia, European Union's Horizon 2020, The University of Melbourne, Clifford Craig Medical Research Trust of Tasmania, The Victorian, Queensland & Tasmanian Asthma Foundations, The Royal Hobart Hospital, Helen MacPherson Smith Trust, and GlaxoSmithKline.
早产与33岁之前的肺功能下降有关，但其对肺功能和慢性阻塞性肺疾病（COPD）的长期影响尚不清楚。为解决这一问题，我们利用塔斯马尼亚纵向健康研究（TAHS）的数据，调查了60岁左右人群中早产、肺功能和COPD之间的关联。
对TAHS的1445名参与者的数据进行分析。在53岁时测量肺功能。孕周分为极早产（28周龄至<32周）、中度早产（32周龄至<34周）、晚期早产（34周龄至<37周）和足月产（≥37周）。采用线性和逻辑回归模型，在调整性别、年龄、身高、孕期父母吸烟情况、年长兄弟姐妹数量、母亲生育年龄和儿童期社会经济地位后，研究早产与肺功能指标（第一秒用力呼气容积[FEV]、用力肺活量[FVC]、FEV/FVC比值、FVC 25%-75%时的用力呼气流量[FEF]、一氧化碳弥散量[DLCO]）以及COPD（支气管扩张剂后FEV/FVC低于正常下限）之间的关联。还研究了与吸烟和哮喘的相互作用。
在TAHS队列中，有3565人有孕周可用数据，其中1445人（41%）纳入本研究，其中740人（51%）为女性。与足月产相比，极早产至中度早产与53岁时患COPD的风险显著增加相关（比值比2.9[95%置信区间1.1-7.7]）。极早产至中度早产还与支气管扩张剂后较低的FEV/FVC比值（β系数-2.9%[95%置信区间-4.9至-0.81]）、FEV（-190 mL[-339至-40]）、DLCO（-0.55 mmol/min/kPa[-0.9至-0.13]）和FEF（-339 mL/s[-664至-14]）相关。极早产至中度早产与FEV/FVC比值之间的关联仅在吸烟者中显著（p=0.0082）。将中度早产作为单独一组分析时，观察到类似结果。与足月产相比，晚期早产与较低的FEV/FVC比值或COPD无关。
这是第一项研究早产对中年肺功能影响的研究。数据表明，极早产至中度早产与阻塞性肺功能缺陷有关，包括在60岁左右人群中的COPD，并且这种影响因个人吸烟而加剧。
澳大利亚国家卫生与医学研究委员会（NHMRC）、欧盟“地平线2020”计划、墨尔本大学、塔斯马尼亚州克利福德·克雷格医学研究信托基金、维多利亚州、昆士兰州和塔斯马尼亚州哮喘基金会、皇家霍巴特医院、海伦·麦克弗森·史密斯信托基金以及葛兰素史克公司。
