Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
National Heart and Lung Institute, Imperial College London, London, UK.
Thorax. 2024 Jul 16;79(8):770-777. doi: 10.1136/thorax-2023-220485.
Lung function in early adulthood is associated with subsequent adverse health outcomes.
To ascertain whether stable and reproducible lung function trajectories can be derived in different populations and investigate their association with objective measures of cardiovascular structure and function.
Using latent profile modelling, we studied three population-based birth cohorts with repeat spirometry data from childhood into early adulthood to identify trajectories of forced expiratory volume in 1 s (FEV)/forced vital capacity (FVC). We used multinomial logistic regression models to investigate early-life predictors of the derived trajectories. We then ascertained the extent of the association between the derived FEV/FVC trajectories and blood pressure and echocardiographic markers of increased cardiovascular risk and stroke in ~3200 participants at age 24 years in one of our cohorts.
We identified four FEV/FVC trajectories with strikingly similar latent profiles across cohorts (pooled N=6377): above average (49.5%); average (38.3%); below average (10.6%); and persistently low (1.7%). Male sex, wheeze, asthma diagnosis/medication and allergic sensitisation were associated with trajectories with diminished lung function in all cohorts. We found evidence of an increase in cardiovascular risk markers ascertained by echocardiography (including left ventricular mass indexed to height and carotid intima-media thickness) with decreasing FEV/FVC (with p values for the mean crude effects per-trajectory ranging from 0.10 to p<0.001). In this analysis, we considered trajectories as a pseudo-continuous variable; we confirmed the assumption of linearity in all the regression models.
Childhood lung function trajectories may serve as predictors in the development of not only future lung disease, but also the cardiovascular disease and multimorbidity in adulthood.
成年早期的肺功能与随后的不良健康结果有关。
确定是否可以在不同人群中得出稳定且可重复的肺功能轨迹，并研究其与心血管结构和功能的客观测量指标的关系。
使用潜在剖面建模，我们研究了三个基于人群的出生队列，这些队列在儿童期至成年早期有重复的肺活量测定数据，以确定 1 秒用力呼气量（FEV）/用力肺活量（FVC）的轨迹。我们使用多项逻辑回归模型来研究早期生活中预测得出的轨迹的因素。然后，我们在我们的一个队列中，在 24 岁时，在大约 3200 名参与者中确定了得出的 FEV/FVC 轨迹与血压和超声心动图标记的心血管风险增加和中风之间的关联程度。
我们在所有队列中都发现了四个 FEV/FVC 轨迹，其潜在特征非常相似（汇总 N=6377）：高于平均水平（49.5%）；平均水平（38.3%）；低于平均水平（10.6%）；和持续低水平（1.7%）。男性、喘息、哮喘诊断/药物治疗和过敏致敏与所有队列中肺功能下降的轨迹有关。我们发现，通过超声心动图确定的心血管风险标志物（包括左心室质量与身高的比值和颈动脉内膜中层厚度）随着 FEV/FVC 的降低而增加（每个轨迹的平均粗效应的 p 值范围从 0.10 到 p<0.001）。在这项分析中，我们将轨迹视为伪连续变量；我们在所有回归模型中都验证了线性假设。
儿童期肺功能轨迹不仅可以预测未来的肺部疾病，还可以预测成年后心血管疾病和多种疾病的发生。
Zotero 插件