背景:肺活量测定结果可以诊断出正常的气流,气流阻塞,或保留比率肺活量测定受损(PRISm),在保留的FEV1/FVC的设置中定义为减少的FEV1或FVC。先前的研究估计PRISm的患病率为7-12%。我们的目标是在肺活量测定数据库中检查PRISm的患病率,并确定与PRISm相关的因素。
方法:我们对21,870个螺旋体进行了回顾性分析;由于数据缺失或年龄极端,排除了1,616个螺旋体,高度,或体重。我们计算了支气管扩张剂前和支气管扩张剂后肺功能检查中PRISm的患病率。随后,我们计算了不同年龄的PRISm患病率,种族,身体质量指数,和诊断类别,以及性别和吸烟者与非吸烟者。最后,在FEV1<正常下限的队列中,我们进行了多变量逻辑回归分析,以确定与PRISm相关的因素.
结果:我们确定了18,059个支气管扩张剂前螺旋体,其中22.3%的患者诊断为PRISm。这种患病率在支气管扩张剂后的肺活量中保持稳定(17.7%),在排除接受多项肺功能检查的受试者的早期肺功能检查后(支气管扩张剂前为20.7%,支气管扩张剂后为24.3%),当我们将分析限制在符合美国胸科学会标准的支气管扩张剂前肺活量时(20.6%).45-60岁受试者的PRISm患病率较高(24.4%),男性(23.7%)高于女性(17.9%)。患病率随着体重指数的增加而上升,转诊诊断为限制性肺病的患病率更高(50%)。种族和吸烟者与非吸烟者之间的PRISm患病率相似。在多变量分析中,预测FEV1的较高百分比(比值比1.51,95%CI1.42-1.60),体重指数(比值比1.52,95%CI1.39-1.68),限制性肺病(比值比4.32,95%CI2.54-7.57)与PRISm的诊断相关.吸烟与PRISm呈负相关(比值比0.55,95%CI0.46-0.65)。
结论:在学术医学中心的肺活量测定数据库中,PRISm患病率为17-24%,比以前报道的要高。
BACKGROUND: Spirometry results can yield a diagnosis of normal air flow, air flow obstruction, or preserved ratio impaired spirometry (PRISm), defined as a reduced FEV1 or FVC in the setting of preserved FEV1/FVC. Previous studies have estimated the prevalence of PRISm to be 7-12%. Our objective was to examine the prevalence of PRISm in a spirometry database and to identify factors associated with PRISm.
METHODS: We performed a retrospective analysis of 21,870 spirometries; 1,616 were excluded because of missing data or extremes of age, height, or weight. We calculated the prevalence of PRISm in prebronchodilator and postbronchodilator pulmonary function tests. Subsequently, we calculated the prevalence of PRISm by various age, race, body mass index, and diagnosis categories, as well as by gender and smokers versus nonsmokers. Finally, in the subset of the cohort with FEV1 < lower limit of normal, we performed a multivariable logistic regression analysis to identify factors associated with PRISm.
RESULTS: We identified 18,059 prebronchodilator spirometries, and 22.3% of these yielded a PRISm diagnosis. This prevalence remained stable in postbronchodilator spirometries (17.7%), after excluding earlier pulmonary function tests for subjects with multiple pulmonary function tests (20.7% in prebronchodilator and 24.3% in postbronchodilator), and when we limited the analysis to prebronchodilator spirometries that met American Thoracic Society criteria (20.6%). The PRISm prevalence was higher in subjects 45-60 y old (24.4%) and in males (23.7%) versus females (17.9%). The prevalence rose with body mass index and was higher for those with a referral diagnosis of restrictive lung disease (50%). PRISm prevalence was similar between races and smokers versus nonsmokers. In a multivariable analysis, higher % of predicted FEV1 (odds ratio 1.51, 95% CI 1.42-1.60), body mass index (odds ratio 1.52, 95% CI 1.39-1.68), and restrictive lung disease (odds ratio 4.32, 95% CI 2.54-7.57) were associated with a diagnosis of PRISm. Smoking was inversely associated (odds ratio 0.55, 95% CI 0.46-0.65) with PRISm.
CONCLUSIONS: In a spirometry database at an academic medical center, the PRISm prevalence was 17-24%, which is higher than previously reported.