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Abstract：
BACKGROUND: Restrictive spirometry pattern (RSP), defined as reduced forced vital capacity (FVC) in absence of airflow obstruction (AFO), is associated with increased risk of mortality in general population. However, evidence in the patients with silicosis is limited. This study was aimed to investigate the relationship between RSP and the risk of death in a silicotic cohort.
METHODS: This retrospective cohort study used data from the Pneumoconiosis Clinic, Hong Kong Department of Health that containing 4315 patients aged 18-80 years and diagnosed with silicosis during 1981-2019, with a follow-up till 31 December 2019. Spirometry was carried out at the diagnostic examination of silicosis. Lung function categories were classified as normal spirometry (FEV1/FVC ≥ 0.7, FVC ≥ 80% predicted), RSP only (FEV1/FVC ≥ 0.7, FVC < 80% predicted), AFO only (FEV1/FVC < 0.7, FVC ≥ 80% predicted), and RSP&AFO mixed (FEV1/FVC < 0.7, FVC < 80% predicted). The hazard ratio (HR) and 95% confidence intervals (95% CI) were computed using a Cox proportional hazards model adjusting for age, body mass index, history of tuberculosis, smoking status, pack-years, and radiographic characteristics of silicotic nodules.
RESULTS: Among the 4315 patients enrolled in the study, the prevalence of RSP was 24.1% (n = 1038), including 11.0% (n = 473) with RSP only and 13.1% (n = 565) with mixed RSP and AFO. During the follow-up period, a total of 2399 (55.6%) deaths were observed. Compared with the silicotics with normal spirometry, those with RSP only had significantly increased risk of all-cause mortality (HR = 1.63, 95% CI 1.44-1.85) and respiratory-related mortality (HR = 1.56, 95% CI 1.31-1.85). Notably, a higher risk of mortality was observed in silicotics with mixed ventilatory defects of both RSP and AFO (all-cause mortality: HR = 2.22, 95% CI 1.95-2.52; respiratory-related mortality: HR = 2.59, 95% CI 2.18-3.07) than in those with RSP only.
CONCLUSIONS: RSP is significantly associated with increased risk of all-cause and respiratory-related mortality in the silicotics, and patients with mixed restrictive and obstructive ventilatory defect have higher risk of mortality than those with single RSP or AFO. These findings emphasize the importance of recognizing RSP in the occupational settings, especially for the silicotic patients with mixed ventilatory defect.
METHODS: This retrospective cohort study used data from the Pneumoconiosis Clinic, Hong Kong Department of Health that containing 4315 patients aged 18-80 years and diagnosed with silicosis during 1981-2019, with a follow-up till 31 December 2019. Spirometry was carried out at the diagnostic examination of silicosis. Lung function categories were classified as normal spirometry (FEV1/FVC ≥ 0.7, FVC ≥ 80% predicted), RSP only (FEV1/FVC ≥ 0.7, FVC < 80% predicted), AFO only (FEV1/FVC < 0.7, FVC ≥ 80% predicted), and RSP&AFO mixed (FEV1/FVC < 0.7, FVC < 80% predicted). The hazard ratio (HR) and 95% confidence intervals (95% CI) were computed using a Cox proportional hazards model adjusting for age, body mass index, history of tuberculosis, smoking status, pack-years, and radiographic characteristics of silicotic nodules.
RESULTS: Among the 4315 patients enrolled in the study, the prevalence of RSP was 24.1% (n = 1038), including 11.0% (n = 473) with RSP only and 13.1% (n = 565) with mixed RSP and AFO. During the follow-up period, a total of 2399 (55.6%) deaths were observed. Compared with the silicotics with normal spirometry, those with RSP only had significantly increased risk of all-cause mortality (HR = 1.63, 95% CI 1.44-1.85) and respiratory-related mortality (HR = 1.56, 95% CI 1.31-1.85). Notably, a higher risk of mortality was observed in silicotics with mixed ventilatory defects of both RSP and AFO (all-cause mortality: HR = 2.22, 95% CI 1.95-2.52; respiratory-related mortality: HR = 2.59, 95% CI 2.18-3.07) than in those with RSP only.
CONCLUSIONS: RSP is significantly associated with increased risk of all-cause and respiratory-related mortality in the silicotics, and patients with mixed restrictive and obstructive ventilatory defect have higher risk of mortality than those with single RSP or AFO. These findings emphasize the importance of recognizing RSP in the occupational settings, especially for the silicotic patients with mixed ventilatory defect.
摘要：
背景：限制性肺活量测定模式（RSP），定义为在没有气流阻塞（AFO）的情况下降低强制肺活量（FVC），与普通人群死亡风险增加有关。然而,矽肺病患者的证据有限.本研究旨在调查矽肺队列中RSP与死亡风险之间的关系。
方法：这项回顾性队列研究使用了尘肺诊所的数据，香港卫生署在1981-2019年期间纳入4315名年龄在18-80岁之间并被诊断为矽肺病的患者，随访至2019年12月31日。在矽肺的诊断检查中进行了肺活量测定。肺功能分类为正常肺活量测定（FEV1/FVC≥0.7，FVC≥80%预测），仅RSP（FEV1/FVC≥0.7，FVC<80%预测），仅AFO（FEV1/FVC<0.7，FVC≥80%预测），RSP和AFO混合（FEV1/FVC<0.7，FVC<80%预测）。风险比（HR）和95％置信区间（95％CI）使用Cox比例风险模型计算调整年龄，身体质量指数,结核病史,吸烟状况,包年，矽肺结节的影像学特征。
结果：在参与研究的4315名患者中，RSP的患病率为24.1％（n=1038），包括11.0%(n=473)仅RSP和13.1%(n=565)混合RSP和AFO。在后续期间,共观察到2399例(55.6%)死亡.与常规肺活量测定的硅质相比，仅RSP患者的全因死亡率(HR=1.63,95%CI1.44-1.85)和呼吸相关死亡率(HR=1.56,95%CI1.31-1.85)风险显著增加.值得注意的是,在具有RSP和AFO两者的混合通气缺陷的硅酸盐中观察到较高的死亡风险(全因死亡率:HR=2.22,95%CI1.95-2.52;呼吸相关死亡率:HR=2.59,95%CI2.18-3.07)。
结论：RSP与全因死亡和呼吸相关死亡的风险增加显著相关，与单一RSP或AFO患者相比，混合型限制性和阻塞性通气缺陷患者的死亡风险更高。这些发现强调了在职业环境中认识RSP的重要性，特别适用于伴有混合性通气缺陷的矽肺患者。
方法：这项回顾性队列研究使用了尘肺诊所的数据，香港卫生署在1981-2019年期间纳入4315名年龄在18-80岁之间并被诊断为矽肺病的患者，随访至2019年12月31日。在矽肺的诊断检查中进行了肺活量测定。肺功能分类为正常肺活量测定（FEV1/FVC≥0.7，FVC≥80%预测），仅RSP（FEV1/FVC≥0.7，FVC<80%预测），仅AFO（FEV1/FVC<0.7，FVC≥80%预测），RSP和AFO混合（FEV1/FVC<0.7，FVC<80%预测）。风险比（HR）和95％置信区间（95％CI）使用Cox比例风险模型计算调整年龄，身体质量指数,结核病史,吸烟状况,包年，矽肺结节的影像学特征。
结果：在参与研究的4315名患者中，RSP的患病率为24.1％（n=1038），包括11.0%(n=473)仅RSP和13.1%(n=565)混合RSP和AFO。在后续期间,共观察到2399例(55.6%)死亡.与常规肺活量测定的硅质相比，仅RSP患者的全因死亡率(HR=1.63,95%CI1.44-1.85)和呼吸相关死亡率(HR=1.56,95%CI1.31-1.85)风险显著增加.值得注意的是,在具有RSP和AFO两者的混合通气缺陷的硅酸盐中观察到较高的死亡风险(全因死亡率:HR=2.22,95%CI1.95-2.52;呼吸相关死亡率:HR=2.59,95%CI2.18-3.07)。
结论：RSP与全因死亡和呼吸相关死亡的风险增加显著相关，与单一RSP或AFO患者相比，混合型限制性和阻塞性通气缺陷患者的死亡风险更高。这些发现强调了在职业环境中认识RSP的重要性，特别适用于伴有混合性通气缺陷的矽肺患者。
