Im Yunjoo, Kim Taeyun, Hwang Jung Hye, Kim Hyunsoo, Hyun Seokmin, Kim So Rae, Shin Sun Hye, Cho Juhee, Kang Danbee, Park Hye Yun
Division of Pulmonology, Allergy, and Critical Care Medicine, Department of Internal Medicine, Kyung Hee University Hospital, College of Medicine, Kyung Hee University, Seoul, Republic of Korea.
Department of Internal Medicine, Kosin University Gospel Hospital, Kosin University College of Medicine, Busan, South Korea.
Ann Am Thorac Soc. 2025 Apr;22(4):486-493. doi: 10.1513/AnnalsATS.202403-250OC.
Numerous studies indicate that preserved-ratio impaired spirometry (PRISm) is associated with adverse clinical outcomes. However, the impact of PRISm severity, particularly in regard to forced vital capacity (FVC), on mortality risk remains unclear. To determine whether PRISm was associated with mortality and to identify specific groups with particularly increased mortality rates. This retrospective study enrolled individuals aged >40 years who underwent comprehensive health screening at the Center for Health Promotion at Samsung Medical Center between 2003 and 2020. PRISm was characterized by a ratio of forced expiratory volume in 1 second to FVC of at least 0.7 and forced expiratory volume in 1 second <80% of predicted values. Participants were classified into three groups: normal lung function, PRISm with normal FVC, and PRISm with low FVC (FVC <80% predicted). We compared all-cause mortality rates using the Kaplan-Meier method and the Cox proportional hazard ratio model. Among 106,458 individuals, 86,208 exhibited normal lung function, 6,249 had PRISm with normal FVC, and 14,001 had PRISm with low FVC. Over a median follow-up of 10.1 years, 2,219 participants died. Individuals with PRISm experienced a higher cumulative mortality rate compared with those with normal lung function (39 vs. 16 per 10,000 person-years; adjusted hazard ratio, 1.43; 95% confidence interval [CI], 1.31-1.56). The fully adjusted hazard ratios for all-cause mortality in PRISm with normal and low FVC were 1.25 (95% CI, 1.03-1.52) and 1.47 (95% CI, 1.33-1.62) relative to those with normal lung function, respectively. PRISm is associated with an increased risk of death, particularly when accompanied by low FVC.
众多研究表明，肺量计检查中保留比值受损（PRISm）与不良临床结局相关。然而，PRISm严重程度，尤其是用力肺活量（FVC）方面，对死亡风险的影响仍不明确。为了确定PRISm是否与死亡率相关，并识别死亡率特别增加的特定群体。这项回顾性研究纳入了2003年至2020年期间在三星医疗中心健康促进中心接受全面健康筛查的40岁以上个体。PRISm的特征是1秒用力呼气容积与FVC的比值至少为0.7，且1秒用力呼气容积<预测值的80%。参与者被分为三组：肺功能正常、FVC正常的PRISm、FVC低的PRISm（FVC<预测值的80%）。我们使用Kaplan-Meier方法和Cox比例风险模型比较全因死亡率。在106458名个体中，86208名肺功能正常，6249名FVC正常的PRISm，14001名FVC低的PRISm。在中位随访10.1年期间，2219名参与者死亡。与肺功能正常的个体相比，PRISm个体的累积死亡率更高（每10000人年分别为39例和16例；调整后的风险比为1.43；95%置信区间[CI]，1.31-1.56）。FVC正常和低的PRISm全因死亡率的完全调整风险比相对于肺功能正常的个体分别为1.25（95%CI，1.03-1.52）和1.47（95%CI，1.33-1.62）。PRISm与死亡风险增加相关，尤其是伴有低FVC时。
