Lin Tong, Jin Shaofeng, Shen Xingkai, Huang Shanshan, Mao Haiyan
Department of Critical Care Medicine, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Department of Geriatrics, Ningbo Medical Center Lihuili Hospital, Ningbo, China.
Front Endocrinol (Lausanne). 2025 May 16;16:1525573. doi: 10.3389/fendo.2025.1525573. eCollection 2025.
Preserved ratio impaired spirometry (PRISm) is a newly defined phenotype of lung function impairment, characterized by a normal FEV1/FVC ratio alongside an FEV1/0.8 < FEV1 predicted value. Previous studies have linked PRISm to various adverse clinical outcomes, but its association with insulin resistance, as indicated by estimated glucose disposal rate (eGDR), remains underexplored.
A total of 13,661 participants were included in this analysis after excluding individuals with missing data on PRISm (n = 10,954) and eGDR (n = 5,827). The median eGDR for the overall sample was calculated, and differences in baseline characteristics between the PRISm and non-PRISm groups were assessed. Logistic regression models were employed to analyze the relationship between eGDR and PRISm, adjusting for various confounders. Subgroup analyses were conducted based on gender and age. Additionally, the restricted cubic spline analysis was used to evaluate the non-linear relationship between eGDR and PRISm, and ROC analysis was performed to determine the predictive accuracy of eGDR for identifying PRISm.
Participants in the PRISm group exhibited significantly lower median eGDR values compared to the non-PRISm group (9.92 vs. 12.01 mg/kg/min; < 0.001), indicating greater insulin resistance. The weighted multivariable logistic regression analysis revealed that each unit increase in eGDR was associated with a 15.1% reduction in the odds of PRISm in unadjusted models, and 7.3% in fully adjusted models (OR = 0.927, 95% CI: 0.880-0.976; = 0.005). Subgroup analyses demonstrated a stronger association between eGDR and PRISm in females and individuals over 40 years of age. The restricted cubic spline analysis indicated a significant non-linear relationship, with an optimal eGDR cutoff of 11.423 mg/kg/min identified via ROC analysis (AUC = 0.626), demonstrating modest predictive accuracy.
Our study demonstrates a significant inverse association between estimated glucose disposal rate (eGDR) and preserved ratio impaired spirometry (PRISm) among a diverse population of US adults. Participants with lower eGDR values exhibited a higher prevalence of PRISm, indicating greater insulin resistance and potential metabolic dysfunction. The findings suggest that eGDR may serve as a valuable marker for assessing the risk of PRISm, particularly among women and older adults.
肺功能测定比值保留受损（PRISm）是一种新定义的肺功能损害表型，其特征为FEV1/FVC比值正常，同时FEV1/0.8低于FEV1预测值。既往研究已将PRISm与多种不良临床结局相关联，但PRISm与胰岛素抵抗（以估计的葡萄糖处置率（eGDR）表示）之间的关联仍未得到充分研究。
在排除PRISm（n = 10,954）和eGDR（n = 5,827）数据缺失的个体后，本分析共纳入13,661名参与者。计算了总体样本的eGDR中位数，并评估了PRISm组和非PRISm组之间基线特征的差异。采用逻辑回归模型分析eGDR与PRISm之间的关系，并对各种混杂因素进行校正。基于性别和年龄进行了亚组分析。此外，使用受限立方样条分析评估eGDR与PRISm之间的非线性关系，并进行ROC分析以确定eGDR对识别PRISm的预测准确性。
与非PRISm组相比，PRISm组参与者的eGDR中位数显著更低（9.92 vs. 12.01 mg/kg/min；P < 0.001），表明胰岛素抵抗更强。加权多变量逻辑回归分析显示，在未校正模型中，eGDR每增加一个单位，PRISm的发生几率降低15.1%，在完全校正模型中降低7.3%（OR = 0.927，95% CI：0.880 - 0.976；P = 0.005）。亚组分析表明，eGDR与PRISm在女性和40岁以上个体中的关联更强。受限立方样条分析表明存在显著的非线性关系，通过ROC分析确定eGDR的最佳截断值为11.423 mg/kg/min（AUC = 0.626），显示出适度的预测准确性。
我们的研究表明，在美国成年人的多样化人群中，估计的葡萄糖处置率（eGDR）与肺功能测定比值保留受损（PRISm）之间存在显著的负相关。eGDR值较低的参与者PRISm患病率较高，表明胰岛素抵抗更强且存在潜在的代谢功能障碍。研究结果表明，eGDR可能是评估PRISm风险的一个有价值的标志物，尤其是在女性和老年人中。
