Stein C E, Kumaran K, Fall C H, Shaheen S O, Osmond C, Barker D J
MRC Environmental Epidemiology Unit, Southampton General Hospital, UK.
Thorax. 1997 Oct;52(10):895-9. doi: 10.1136/thx.52.10.895.
Follow up studies in Britain have shown that low rates of fetal growth are followed by reduced lung function in adult life, independent of smoking and social class. It is suggested that fetal adaptations to undernutrition in utero result in permanent changes in lung structure, which in turn lead to chronic airflow obstruction. India has high rates of intrauterine growth retardation, but no study has examined the association between fetal growth and adult lung function in Indian people. We have related size at birth to lung function in an urban Indian population aged 38-59 years.
Two hundred and eighty six men and women born in one hospital in Mysore City, South India, during 1934-1953 were traced by a house-to-house survey of the city. Their mean forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) were measured using a turbine spirometer. These measurements were linked to their size at birth, recorded at the time.
In both men and women mean FEV1 fell with decreasing birthweight. Adjusted for age and height, it fell by 0.09 litres with each pound (454 g) decrease in birthweight in men (95% confidence interval (CI) 0.01 to 0.16) and by 0.06 (95% CI -0.01 to 0.13) in women. Likewise, mean FVC fell by 0.11 litres (95% CI 0.02 to 0.19) with each pound decrease in birthweight in men, and by 0.08 litres (95% CI 0.002 to 0.16) in women. FEV1 and FVC were lower in men who smoked, but the associations with size at birth were independent of smoking. Small head circumference at birth was associated with a low FEV1/FVC ratio in men which may reflect restriction in airway growth in early gestation.
This is further evidence that adult lung function is "programmed" in fetal life. Smoking may be particularly detrimental to the lung function of populations already disadvantaged by poor rates of fetal growth.
英国的随访研究表明，胎儿生长率低会导致成年后肺功能下降，且与吸烟和社会阶层无关。有人认为，胎儿在子宫内对营养不良的适应会导致肺结构的永久性改变，进而导致慢性气流阻塞。印度的宫内生长迟缓率很高，但尚无研究探讨印度人群中胎儿生长与成年后肺功能之间的关联。我们将印度城市中38至59岁人群的出生时大小与肺功能联系起来进行了研究。
通过对印度南部迈索尔市的挨家挨户调查，追踪了1934年至1953年期间在该市一家医院出生的286名男性和女性。使用涡轮肺活量计测量他们的一秒用力呼气量（FEV1）和用力肺活量（FVC）。这些测量结果与他们出生时的大小相关联，这些数据在当时有记录。
男性和女性的平均FEV1均随着出生体重的降低而下降。在调整了年龄和身高后，男性出生体重每降低一磅（454克），FEV1下降0.09升（95%置信区间（CI）为0.01至0.16），女性下降0.06升（95%CI为-0.01至0.13）。同样，男性出生体重每降低一磅，平均FVC下降0.11升（95%CI为0.02至0.19），女性下降0.08升（95%CI为0.002至0.16）。吸烟男性的FEV1和FVC较低，但与出生时大小的关联与吸烟无关。出生时头围小与男性较低的FEV1/FVC比值相关，这可能反映了妊娠早期气道生长受限。
这进一步证明成年后的肺功能在胎儿期就已“编程”。吸烟可能对那些因胎儿生长率低而处于不利地位的人群的肺功能特别有害。
