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探索衰弱与慢性阻塞性肺疾病之间的因果关系:来自双向孟德尔随机化和中介分析的见解

Exploring the Causal Relationship Between Frailty and Chronic Obstructive Pulmonary Disease: Insights From Bidirectional Mendelian Randomization and Mediation Analysis.

作者信息

Cheng Zewen, Wu Jian, Xu Chun, Yan Xiaokun

机构信息

Department of Thoracic Surgery, Suzhou Hospital of Integrated Traditional Chinese and Western Medicine, Suzhou, Jiangsu, 215000, People's Republic of China.

Department of Cardio-Thoracic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, 215000, People's Republic of China.

出版信息

Int J Chron Obstruct Pulmon Dis. 2025 Jan 25;20:193-205. doi: 10.2147/COPD.S501635. eCollection 2025.


DOI:10.2147/COPD.S501635
PMID:39881812
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11776522/
Abstract

BACKGROUND: Observational studies have underscored a robust association between frailty and chronic obstructive pulmonary disease (COPD), yet the causality remains equivocal. METHODS: This study employed bidirectional two-sample Mendelian randomization (MR) analysis. Univariable MR investigated the causal relationship between frailty and COPD. Genetic correlation was assessed using linkage disequilibrium score (LDSC) regression. Multivariable MR and mediation analysis explored the influence of various confounders and their mediating effects. The primary analytic approach was inverse variance weighted (IVW). RESULTS: LDSC analysis revealed moderate genetic correlations between frailty and Global Biobank Meta-Analysis Initiative (GBMI) COPD (r = 0.643, = 6.66×10) as well as FinnGen COPD (r = 0.457, = 8.20×10). IVW analysis demonstrated that frailty was associated with increased risk of COPD in both the GBMI cohort (95% CI, 1.475 to 2.158; = 2.40×10) and the FinnGen database (1.411 to 2.434; 9.02×10). Concurrently, COPD was identified as a susceptibility factor for frailty ( < 0.05). These consistent findings persisted after adjustment for potential confounders in MVMR. Additionally, mediation analysis revealed that walking pace mediated 19.11% and 15.40% of the impact of frailty on COPD risk, and 17.58% and 23.26% of the effect of COPD on frailty risk in the GBMI and FinnGen cohorts, respectively. CONCLUSION: This study has strengthened the current evidence affirming a reciprocal causal relationship between frailty and COPD, highlighting walking pace as a pivotal mediator.

摘要

背景:观察性研究强调了衰弱与慢性阻塞性肺疾病(COPD)之间存在密切关联,但因果关系仍不明确。 方法:本研究采用双向两样本孟德尔随机化(MR)分析。单变量MR研究了衰弱与COPD之间的因果关系。使用连锁不平衡评分(LDSC)回归评估遗传相关性。多变量MR和中介分析探讨了各种混杂因素的影响及其中介作用。主要分析方法为逆方差加权(IVW)。 结果:LDSC分析显示,衰弱与全球生物银行荟萃分析倡议(GBMI)COPD(r = 0.643, = 6.66×10)以及芬兰基因库COPD(r = 0.457, = 8.20×10)之间存在中等程度的遗传相关性。IVW分析表明,在GBMI队列(95%CI,1.475至2.158; = 2.40×10)和芬兰基因库数据库(1.411至2.434;9.02×10)中,衰弱均与COPD风险增加相关。同时,COPD被确定为衰弱的一个易感因素( < 0.05)。在多变量MR中对潜在混杂因素进行调整后,这些一致的结果依然存在。此外,中介分析显示,在GBMI和芬兰基因库队列中,步行速度分别介导了衰弱对COPD风险影响的19.11%和15.40%,以及COPD对衰弱风险影响的17.58%和23.26%。 结论:本研究强化了当前证据,证实了衰弱与COPD之间存在相互因果关系,突出了步行速度作为关键中介因素的作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/5f452ff11212/COPD-20-193-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/dcfe5c16220b/COPD-20-193-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/3361163a1817/COPD-20-193-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/6de8106fd251/COPD-20-193-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/37e69cb250bb/COPD-20-193-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/c8f0af773e1c/COPD-20-193-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/5f452ff11212/COPD-20-193-g0006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/dcfe5c16220b/COPD-20-193-g0001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/3361163a1817/COPD-20-193-g0002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/6de8106fd251/COPD-20-193-g0003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/37e69cb250bb/COPD-20-193-g0004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/c8f0af773e1c/COPD-20-193-g0005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/018b/11776522/5f452ff11212/COPD-20-193-g0006.jpg

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引用本文的文献

[1]
Frailty in COPD: Clinical Impact, Diagnosis, Biomarkers, and Management Strategies.

Int J Chron Obstruct Pulmon Dis. 2025-7-15

[2]
Relationship Between COPD Progression and Frailty Progression: A Five-year Observation in Real Clinical Practice.

Int J Chron Obstruct Pulmon Dis. 2025-6-14

本文引用的文献

[1]
Investigating the prognostic value of digital mobility outcomes in patients with chronic obstructive pulmonary disease: a systematic literature review and meta-analysis.

Eur Respir Rev. 2023-11-22

[2]
The association between walking pace and hand grip strength with the risk of chronic obstructive pulmonary disease: a bidirectional Mendelian randomization study.

BMC Pulm Med. 2023-11-20

[3]
Mendelian randomization.

Nat Rev Methods Primers. 2022-2-10

[4]
Prevalence and clinical impact of frailty in COPD: a systematic review and meta-analysis.

BMC Pulm Med. 2023-5-12

[5]
Association of Prefrailty and Frailty With All-Cause Mortality, Acute Exacerbation, and Hospitalization in Patients With Chronic Obstructive Pulmonary Disease: A Meta-Analysis.

J Am Med Dir Assoc. 2023-7

[6]
Global Biobank Meta-analysis Initiative: Powering genetic discovery across human disease.

Cell Genom. 2022-10-12

[7]
Comparative effectiveness of non-pharmacological interventions for frailty: a systematic review and network meta-analysis.

Age Ageing. 2023-2-1

[8]
FinnGen provides genetic insights from a well-phenotyped isolated population.

Nature. 2023-1

[9]
Frailty and cardiometabolic diseases: a bidirectional Mendelian randomisation study.

Age Ageing. 2022-11-2

[10]
Inflammation and cell-to-cell communication, two related aspects in frailty.

Immun Ageing. 2022-10-26

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