在拉丁美洲的一个基于人群的队列中，肺量计模式、阻塞和 PRISm 的轨迹。

Trajectories of Spirometric Patterns, Obstructive and PRISm, in a Population-Based Cohort in Latin America.

机构信息

National Institute of Respiratory Diseases, Mexico City, Mexico.

Pulmonary Division, Hospital Universitario de Caracas, Universidad Central de Venezuela, and Centro Medico de Caracas, Caracas, Venezuela.

出版信息

Int J Chron Obstruct Pulmon Dis. 2023 Jun 21;18:1277-1285. doi: 10.2147/COPD.S406208. eCollection 2023.

DOI:10.2147/COPD.S406208

PMID:37366430

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10290847/

Abstract

BACKGROUND

Preserved ratio impaired spirometry (PRISm) has been associated with adverse outcomes and increased transition to other spirometric categories over time. We aimed to examine its prevalence, trajectories over time, and outcomes in a population-based sample from Latin America.

METHODS

Data were obtained from two population-based surveys of adults from three cities in Latin America (PLATINO study), conducted on the same individuals 5-9 years after their baseline examination. We estimated the frequency of PRISm defined by FEV/FVC≥0.70 with FEV <80%, describing their clinical characteristics, longitudinal transition trajectories over time, factors associated with the transition.

RESULTS

At baseline, 2942 participants completed post-bronchodilator spirometry, and 2026 at both evaluations. The prevalence of normal spirometry was 78%, GOLD-stage 1 10.6%, GOLD 2-4 6.5%, and PRISm was: 5.0% (95% CI 4.2-5.8). PRISm was associated with less schooling, more reports of physician-diagnosis of COPD, wheezing, dyspnea, missing days at work, having ≥2 exacerbations in the previous year but without accelerated lung function decline. Mortality risk was significantly higher in PRISm (HR 1.97, 95% CI 1.2-3.3) and COPD GOLD 1-4 categories (HR 1.79, 95% CI 1.3-2.4) compared with normal spirometry. PRISm at baseline most frequently transitioned to another category at follow-up (46.5%); 26.7% to normal spirometry and 19.8% to COPD. The best predictors of transition to COPD were closeness of FEV/FVC to 0.70, older age, current smoking, and a longer FET in the second assessment.

CONCLUSION

PRISm, is a heterogeneous and unstable condition prone to adverse outcomes that require adequate follow-up.

摘要

背景

保留比受损的肺活量测定法（PRISm）与不良结局以及随着时间的推移向其他肺活量测定法类别过渡有关。我们旨在检查其在拉丁美洲人群中的患病率、随时间的变化轨迹和结局。

方法

数据来自拉丁美洲三个城市的两项基于人群的成年人调查（PLATINO 研究），在基线检查后 5-9 年对同一人群进行了两次检查。我们估计了用 FEV/FVC≥0.70 定义的 PRISm 的频率，FEV<80%，描述了其临床特征、随时间的纵向过渡轨迹以及与过渡相关的因素。

结果

在基线时，2942 名参与者完成了支气管扩张剂后肺活量测定，其中 2026 名在两次评估中都完成了。正常肺活量测定法的患病率为 78%，GOLD 阶段 1 为 10.6%，GOLD 2-4 为 6.5%，PRISm 为：5.0%（95%CI 4.2-5.8）。PRISm 与受教育程度较低、更多报告有医生诊断的 COPD、喘息、呼吸困难、缺勤天数较多、前一年有≥2 次加重但没有加速肺功能下降有关。与正常肺活量测定法相比，PRISm（HR 1.97，95%CI 1.2-3.3）和 COPD GOLD 1-4 类别的死亡率风险显著更高（HR 1.79，95%CI 1.3-2.4）。与正常肺活量测定法相比，PRISm 在基线时最常过渡到随访中的另一个类别（46.5%）；26.7%过渡到正常肺活量测定法，19.8%过渡到 COPD。向 COPD 过渡的最佳预测因素是 FEV/FVC 更接近 0.70、年龄较大、当前吸烟以及第二次评估中的 FET 更长。