Dai Cuiqiong, Tang Gaoying, Yang Huajing, Wu Fan, Deng Zhishan, Zheng Youlan, Zhao Ningning, Lu Lifei, Wan Qi, Wang Zihui, Peng Jieqi, Wu Xiaohui, Zhou Kunning, Cai Guannan, Xiao Shan, Wen Xiang, Yang Changli, Chen Shengtang, Yu Shuqing, Sun Ruiting, Zhou Yumin, Ran Pixin
State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease & National Center for Respiratory Medicine & Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, People's Republic of China.
Guangzhou National Laboratory, Guangzhou, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 May 26;20:1711-1722. doi: 10.2147/COPD.S514181. eCollection 2025.
Preserved ratio impaired spirometry (PRISm), which identifies a population at high risk for COPD, has drawn increasing attention. However, definitions for PRISm vary across studies, and researches comparing these definitions are limited.
We aim to assess the agreement, the clinical features, and the prevalence of PRISm defined by restrictive spirometric pattern (RSP) method [that is forced vital capacity (FVC) method] versus forced expiratory volume in the first second (FEV) method and by fixed values versus the lower limit of normal (LLN).
All 1862 participants from the ECOPD study underwent questionnaire investigation, spirometry, biphasic CT, and impulse oscillometry. Participants were categorized into control and two targeted groups (RSP fixed and PRISm fixed excluding RSP fixed) based on FVC and FEV fixed definitions. Similar categorizations were conducted for RSP LLN versus PRISm LLN and PRISm fixed versus PRISm LLN. We assessed the agreement, the clinical features, and the prevalence of PRISm among these various definitions, repeating all analyses using Global Lung function Initiative (GLI) equation.
Significant overlap with merely moderate agreement (Kappa coefficient = 0.706, P value <0.001) existed between RSP fixed and PRISm fixed definitions. Participants identified as PRISm by both definitions exhibited lower lung function, higher airway reactance, and increased airway resistance compared to the control group. Similar findings were observed in RSP LLN versus PRISm LLN and PRISm fixed versus PRISm LLN. Our sensitivity analysis verified the consistency of these results. Furthermore, the prevalence of PRISm varied from 2.0% to 12.5% depending on the definitions and predicted equations, with the Chinese equation, LLN definition in Chinese equation and fixed definition in GLI equation yielding higher prevalence rates.
Our findings highlight concerns about the comparability of studies and the interchangeability of various definitions and reference equations for PRISm.
用于识别慢性阻塞性肺疾病（COPD）高危人群的肺功能测定中保存率受损（PRISm）已引起越来越多的关注。然而，不同研究中PRISm的定义各不相同，且比较这些定义的研究有限。
我们旨在评估通过限制性肺量计模式（RSP）方法[即用力肺活量（FVC）方法]与第一秒用力呼气量（FEV）方法以及固定值与正常下限（LLN）定义的PRISm之间的一致性、临床特征和患病率。
慢性阻塞性肺疾病加重期（ECOPD）研究中的所有1862名参与者均接受了问卷调查、肺量计检查、双相CT检查和脉冲振荡法检查。根据FVC和FEV固定定义，将参与者分为对照组和两个目标组（RSP固定组和排除RSP固定组的PRISm固定组）。对RSP LLN与PRISm LLN以及PRISm固定组与PRISm LLN进行了类似的分类。我们评估了这些不同定义中PRISm的一致性、临床特征和患病率，并使用全球肺功能倡议（GLI）方程重复了所有分析。
RSP固定定义和PRISm固定定义之间存在显著重叠，但一致性仅为中等（卡帕系数 = 0.706，P值<0.001）。与对照组相比，两种定义均被确定为PRISm的参与者肺功能较低、气道反应性较高且气道阻力增加。在RSP LLN与PRISm LLN以及PRISm固定组与PRISm LLN之间也观察到了类似的结果。我们的敏感性分析验证了这些结果的一致性。此外，根据定义和预测方程，PRISm的患病率在2.0%至12.5%之间变化，其中中国方程、中国方程中的LLN定义和GLI方程中的固定定义患病率较高。
我们的研究结果突出了对PRISm研究可比性以及各种定义和参考方程可互换性的担忧。
