基于社区居民的保留比率的肺量计异常人群特征研究
ssociated Factors and Characteristics of PRISm：a Study based on Community Residents
背景 20%~30%的保留比率的肺量计异常（PRISm）会发展为慢性阻塞性肺疾病（COPD），但我国目前对其特征的研究非常有限。目的 分析PRISm的影响因素，探讨PRISm人群与COPD患者在危险因素分布特征上的差异。方法 本研究依托上海市社区健康管理工作开展，选取2022年7月—2023年6月在上海市普陀区11个社区参加COPD早期筛查的60岁以上社区老年人进行问卷调查和肺功能检测。共876人参加了本次调查，剔除141例问卷信息不完整或肺功能检测质量不合格的对象，最终得到研究对象735例。根据《慢性阻塞性肺疾病分级诊疗服务技术方案》和GOLD 2024，以吸入支气管舒张剂后的肺功能对研究对象进行分组：COPD组（FEV1/FVC<70%），PRISm组［FEV1与预计值之比（FEV1%Pred）<80%且FEV1/FVC≥70%］，肺功能正常组（FEV1%Pred≥80%且FEV1/FVC≥70%）。以肺功能正常组为对照，通过多因素Logistic回归分析探讨COPD、PRISm的相关因素。结果 COPD组157例（21.36%），PRISm组113例（15.37%），肺功能正常组465例（63.27%）。三组COPD-SQ总分比较，COPD组评分最高（20.46±4.53），PRISm组次之（19.04±4.41），肺功能正常组评分最低（18.03±4.26），差异有统计学意义（P<0.001）。单因素分析结果显示：PRISm组男性比例、吸烟量、存在反复发作的喘息比例、有慢性支气管炎比例、有高血压比例高于肺功能正常组（P<0.05）；但与COPD组相比，PRISm人群男性比例、吸烟量、存在运动后喘息或咳嗽症状比例、有肺气肿比例均较低，但高血压患病率却较高（P<0.05）。多因素Logistic回归分析显示：年龄增大、性别为男性、吸烟量增加、身体活动不足、存在反复发作的喘息、存在运动后喘息或咳嗽、有慢阻肺或支气管哮喘家族史、有支气管哮喘或肺气肿是COPD的相关因素（P<0.05，AUC=0.79）；而吸烟量增加、身体活动不足、存在反复发作的喘息、有慢性支气管炎和有高血压是PRISm的相关因素（P<0.05，AUC=0.67）。结论 PRISm是介于COPD和肺功能正常间的一种高危状态，其在年龄、吸烟、身体活动、症状及疾病史分布上与COPD类似，但COPDSQ评分及Logistic回归模型对于肺功能状态的预测效果（AUC）显著低于COPD。高血压仅在PRISm中为独立相关因素，提示PRISm人群可能存在独立于COPD的心血管疾病风险。而PRISm人群特征在疾病进展中的作用仍待进一步验证。
Background20%~30% of individuals with Preserved Ratio Impaired SpirometryPRISmwill develop chronic obstructive pulmonary diseaseCOPD. However studies on characteristics of PRISm in China remain limited. Objective To analyze factors associated with PRISmand to explore the difference in the distribution of risk factors between individuals with PRISm and COPD. MethodsThis study was conducted as part of health management in Shanghai communities. Elderly individuals over 60 years old from 11 communities in Putuo DistrictShanghaiwho participated COPD screening from July 2022 to June 2023were surveyed and underwent lung function tests. A total of 876 participants were initially includedbut 141 were excluded due to incomplete questionnaire information or poor lung function test qualityresulting in 735 valid subjects. According to the "Guidelines for Graded Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease" and GOLD 2024participants were classified into three subgroups based on post-bronchodilator lung functionCOPD groupFEV1/FVC< 70%PRISm groupFEV1%Pred<80% and FEV1/FVC 70%and normal lung function group. Multivariate logistic regression analyses were conducted to identify factors associated with COPD and PRISmusing normal lung function as the control. Area under ROC CurveAUCand scores from COPD Screening QuestionnaireCOPD-SQwere calculated to assess the difference between COPDPRISm and normal lung function. ResultsA total of 735 individuals aged 60~81 were included. COPD and PRISm were observed in 15721.36%and 11315.37%participantsrespectively. COPD-SQ scores were highest in the COPD group 20.464.53followed by the PRISm group19.044.41and lowest in the normal lung function group18.034.26 with statistically significant differencesP<0.001. Univariate analysis showed that the PRISm group had higher proportions of malessmokersindividuals with frequent wheezingchronic bronchitis and hypertension compared to the normal lung function groupP<0.05. Compared to COPD patientsthe PRISm group had lower proportions of malessmokersindividuals with symptoms of wheezing or coughing after exerciseand those with a history of emphysemabut a higher prevalence of hypertension P<0.05. Multivariable Logistic regression analyses revealed that increasing agemale genderhigher smoking levels insufficient physical activityfrequent wheezingwheezing or coughing after exercisefamily history of COPD or bronchial asthmaand history of bronchial asthma or emphysema were associated with COPDP<0.05AUC=0.79. In contrasthigher smoking levelsinsufficient physical activityfrequent wheezingchronic bronchitisand hypertension were associated with PRISmP<0.05AUC=0.67. ConclusionPRISm is a high-risk state between COPD and normal lung functionsharing similar associated factors with COPD such as agesmoking statesphysical activitysymptoms and comorbidities. However the COPD-SQ score and the predictive performance of multivariable logistic regression modelAUCfor lung function status were significantly lower for PRISm compared to COPD. Hypertension was an independent associated factor for PRISmbut not for COPDsuggesting a potential risk of cardiovascular disease independent of COPD. Further research is warranted to verify the role of PRISm characteristics in disease progression.
路宇晴、张锋英、于杰、吴春香、宋荣维
内科学临床医学基础医学
肺疾病，慢性阻塞性保留比率的肺量计异常社区疾病特征社区居民
路宇晴,张锋英,于杰,吴春香,宋荣维.基于社区居民的保留比率的肺量计异常人群特征研究[EB/OL].(2024-11-22)[2025-08-16].https://chinaxiv.org/abs/202411.00240.点此复制
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