背景:肺功能发育和下降的生命周期轨迹会影响肺部疾病的风险,但文献报道很少。
目的:记录从童年到中年的肺功能轨迹。
方法:我们模拟了1s的用力呼气量(FEV1),9,11,13,15,18,21,26,32,38和45岁人群队列的强迫肺活量(FVC)和FEV1/FVC使用潜在谱分析,以确定具有相似肺功能轨迹的参与者的不同亚组.回归分析用于评估轨迹之间的关联,45岁时早期生活因素和支气管扩张剂后气流阻塞。
结果:在865名具有≥6项肺功能测量值的参与者中,我们确定了10个不同的FEV1轨迹。大多数是大致平行的,除了儿童气道高反应相关的持续低轨迹(研究人群的3%);两个加速下降轨迹,其中之一(8%)与吸烟和较高的成人体重指数(BMI)以及追赶轨迹(8%)有关.FEV1/FVC轨迹的结果相似。确定了FVC的9条轨迹:除了与BMI相关的加速下降轨迹较高之外,大多数轨迹也大致平行。导致最低FEV1值的三个FEV1轨迹占队列的19%,但在45岁时占气流阻塞的55%。
结论:中年人的肺功能轨迹主要在青春期之前建立,除了少数例外:儿童气道高反应性相关的持续低轨迹,开始很低,随着年龄的增长变得更糟,以及与吸烟和肥胖相关的加速成人衰退轨迹。不利的轨迹与成人中年气流阻塞的高风险有关。
BACKGROUND: Life course trajectories of lung function development and decline influence the risk for lung disease but are poorly documented.
OBJECTIVE: To document lung function trajectories from childhood to mid-adult life.
METHODS: We modelled forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and FEV1/FVC at ages 9, 11, 13, 15, 18, 21, 26, 32, 38 and 45 years from a population-based cohort using latent profile analysis to identify distinct subgroups of participants with similar lung function trajectories. Regression analyses were used to assess associations between the trajectories, early life factors and postbronchodilator airflow obstruction at age 45.
RESULTS: Among 865 participants with ≥6 measures of lung function, we identified 10 distinct FEV1 trajectories. Most were approximately parallel except for a childhood airway hyper-responsiveness-related persistently low trajectory (3% of study population); two accelerated-decline trajectories, one of which (8%) was associated with smoking and higher adult body mass index (BMI) and a catch-up trajectory (8%). Findings for FEV1/FVC trajectories were similar. Nine trajectories were identified for FVC: most were also approximately parallel except for a higher BMI-related accelerated-decline trajectory. The three FEV1 trajectories leading to the lowest FEV1 values comprised 19% of the cohort but contributed 55% of airflow obstruction at age 45.
CONCLUSIONS: Lung function trajectories to mid-adult life are largely established before adolescence, with a few exceptions: a childhood airway hyper-responsiveness-related persistently low trajectory, which starts low and gets worse with age, and accelerated adult decline trajectories associated with smoking and obesity. Adverse trajectories are associated with a high risk of airflow obstruction in mid-adult life.