从童年到成年中期肺功能的不同轨迹。

IF 9 1区 医学 Q1 RESPIRATORY SYSTEM Thorax Pub Date : 2024-07-16 DOI:10.1136/thorax-2023-220436
Xian Zhang, Andrew R Gray, Robert J Hancox
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引用次数: 0

摘要

理由:肺功能发展和衰退的生命历程轨迹影响着肺部疾病的风险,但却鲜有记录:肺功能发展和衰退的生命过程轨迹会影响肺部疾病的风险,但这方面的文献却很少:目的:记录从童年到成年中期的肺功能轨迹:方法:我们利用潜伏特征分析,从基于人群的队列中模拟了 9、11、13、15、18、21、26、32、38 和 45 岁时的 1 秒用力呼气容积 (FEV1)、用力肺活量 (FVC) 和 FEV1/FVC,以识别具有相似肺功能轨迹的不同参与者亚群。回归分析用于评估肺功能轨迹、早期生活因素和45岁时支气管扩张剂后气流阻塞之间的关系:结果:在肺功能测量指标≥6项的865名参与者中,我们发现了10种不同的FEV1轨迹。除了一条与儿童气道高反应性相关的持续低值轨迹(占研究人群的 3%)、两条加速下降轨迹(其中一条(8%)与吸烟和成年体重指数(BMI)较高有关)和一条追赶轨迹(8%)外,大多数轨迹大致平行。FEV1/FVC轨迹的研究结果类似。发现了九条 FVC 的轨迹:除了一条与较高的 BMI 相关的加速下降轨迹外,大多数轨迹也近似平行。导致 FEV1 值最低的三个 FEV1 轨迹占队列的 19%,但在 45 岁时造成了 55% 的气流阻塞:到中年时的肺功能轨迹大多在青春期之前就已确定,但也有少数例外:与儿童气道高反应性相关的持续低水平轨迹(起始值低且随年龄增长而恶化),以及与吸烟和肥胖相关的成年加速下降轨迹。不良轨迹与中年气流阻塞的高风险有关。
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Distinct trajectories of lung function from childhood to mid-adulthood.

Rationale: 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.

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来源期刊
Thorax
Thorax 医学-呼吸系统
CiteScore
16.10
自引率
2.00%
发文量
197
审稿时长
1 months
期刊介绍: Thorax stands as one of the premier respiratory medicine journals globally, featuring clinical and experimental research articles spanning respiratory medicine, pediatrics, immunology, pharmacology, pathology, and surgery. The journal's mission is to publish noteworthy advancements in scientific understanding that are poised to influence clinical practice significantly. This encompasses articles delving into basic and translational mechanisms applicable to clinical material, covering areas such as cell and molecular biology, genetics, epidemiology, and immunology.
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