Department of Epidemiology and Biostatistics, School of Public Health, Medical College of Soochow University, Suzhou, China.
Providence VA Medical Center, Providence, RI; Division of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, RI.
Chest. 2023 Nov;164(5):1268-1280. doi: 10.1016/j.chest.2023.05.031. Epub 2023 Jun 17.
The prospective associations of preserved ratio impaired spirometry (PRISm) with new-onset macrovascular and microvascular complications and mortality among individuals with type 2 diabetes (T2D) and whether PRISm enhances the prediction ability of an established office-based risk score remain to be elucidated.
Can PRISm be used as a predictor of poor prognosis in individuals with T2D?
We included 20,047 study participants with T2D and complete data on spirometry at recruitment from the UK Biobank cohort. Multivariable Cox proportional hazards models were used to assess the associations of baseline PRISm (FEV to FVC ratio, ≥ 0.70; FEV, < 80% predicted) with subsequent risks of incident stroke (any type), ischemic stroke, myocardial infarction, unstable angina, coronary heart disease, diabetic retinopathy, diabetic kidney disease, all-cause mortality, cardiovascular mortality, and respiratory mortality.
For this cohort analysis, 4,521 patients (22.55% of participants with T2D) showed comorbid PRISm at baseline. Over a median follow-up of 11.52 to 11.87 years, patients with T2D with PRISm at baseline showed higher risks than those with normal spirometry findings of various T2D complications developing and mortality; the adjusted hazard ratios for PRISm were 1.413 (95% CI, 1.187-1.681) for stroke (any type), 1.382 (95% CI, 1.129-1.690) for ischemic stroke, 1.253 (95% CI, 1.045-1.503) for myocardial infarction, 1.206 (95% CI, 1.086-1.339) for coronary heart disease, 1.311 (95% CI, 1.141-1.506) for diabetic retinopathy, 1.384 (95% CI, 1.190-1.610) for diabetic kidney disease, 1.337 (95% CI, 1.213-1.474) for all-cause mortality, 1.597 (95% CI, 1.296-1.967) for cardiovascular mortality, and 1.559 (95% CI, 1.189-2.044) for respiratory mortality, respectively. The addition of PRISm significantly improved the reclassification ability, based on the net reclassification index, of an office-based risk score by 15.53% (95% CI, 10.14%-19.63%) to 33.60% (95% CI, 20.90%-45.79%).
Individuals with T2D with comorbid PRISm, accounting for a considerable proportion of the population with T2D, showed significantly increased risks of adverse macrovascular and microvascular complications and mortality.
在 2 型糖尿病（T2D）患者中，保留的比受损的肺活量测定（PRISm）与新发大血管和微血管并发症以及死亡率之间的前瞻性关联，以及 PRISm 是否增强了既定的基于办公室的风险评分的预测能力，仍有待阐明。
PRISm 能否用于预测 T2D 患者的预后不良？
我们纳入了来自英国生物库队列的 20047 名 T2D 患者，他们在招募时均有完整的肺活量测定数据。多变量 Cox 比例风险模型用于评估基线 PRISm（FEV 与 FVC 之比，≥0.70；FEV，<80%预测）与随后发生中风（任何类型）、缺血性中风、心肌梗死、不稳定型心绞痛、冠心病、糖尿病视网膜病变、糖尿病肾病、全因死亡率、心血管死亡率和呼吸死亡率的风险之间的关联。
对于这项队列分析，4521 名患者（T2D 患者的 22.55%）在基线时同时存在合并 PRISm。在中位随访时间为 11.52 至 11.87 年期间，与正常肺功能检查结果相比，基线时患有 T2D 合并 PRISm 的患者发生各种 T2D 并发症和死亡的风险更高；PRISm 的调整后危险比为中风（任何类型）为 1.413（95%CI，1.187-1.681），缺血性中风为 1.382（95%CI，1.129-1.690），心肌梗死为 1.253（95%CI，1.045-1.503），冠心病为 1.206（95%CI，1.086-1.339），糖尿病视网膜病变为 1.311（95%CI，1.141-1.506），糖尿病肾病为 1.384（95%CI，1.190-1.610），全因死亡率为 1.337（95%CI，1.213-1.474），心血管死亡率为 1.597（95%CI，1.296-1.967），呼吸死亡率为 1.559（95%CI，1.189-2.044）。基于净重新分类指数，基于办公室的风险评分的重新分类能力显著提高，增加了 15.53%（95%CI，10.14%-19.63%）至 33.60%（95%CI，20.90%-45.79%）。
患有 T2D 合并 PRISm 的患者，占 T2D 人群的相当大比例，其发生不良大血管和微血管并发症以及死亡率的风险显著增加。
