关注保留比率的肺功能减损（PRISm）的慢性阻塞性肺疾病表型

doi:10.16150/j.1671-2870.2023.03.05

诊断学理论与实践 ›› 2023, Vol. 22 ›› Issue (03): 234-237.doi: 10.16150/j.1671-2870.2023.03.05

关注保留比率的肺功能减损（PRISm）的慢性阻塞性肺疾病表型

孙娴雯, 李庆云()

上海交通大学医学院附属瑞金医院呼吸与危重症医学科，上海交通大学医学院呼吸病研究所，上海市呼吸传染病应急防控与诊治重点实验室，上海 200025

收稿日期:2023-05-08 出版日期:2023-06-25 发布日期:2023-11-17
通讯作者: 李庆云 E-mail：liqingyun68@hotmai.com
基金资助:
国家自然科学基金青年项目(82200041)

Phenotypes of chronic obstructive pulmonary disease with preserved ratio impaired spirometry (PRISm)

SUN Xianwen, LI Qingyun()

Department of Respiratory and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine,Institute of Respiratory Diseases, School of Medicine, Shanghai Jiao Tong University, Shanghai Key Laboratory for Emergency Prevention, Control, and Diagnosis of Respiratory Infectious Diseases, Shanghai 200025

Received:2023-05-08 Online:2023-06-25 Published:2023-11-17

摘要/Abstract

摘要：

2023版慢性阻塞性肺疾病全球倡议（Global Initiative for Chronic Obstructive Lung Disease，GOLD）（2023版GOLD）首次提出了“保留比率的肺功能受减损（preserved ratio impaired spirometry，PRISm）”的概念，即受检者吸入支气管扩张剂后，第一秒用力呼气量占用力肺活量百分率（percentage of forced expiratory volume in first seco-nd to forced vital capacity， FEV₁/FVC）≥0.7（即一秒率正常），但患者存在肺通气功能减损，表现为吸入支气管扩张剂后，FEV₁占预计值百分比（FEV₁%）<80%和（或）FVC占预计值百分比（FVC%）<80%。PRISm与COPD并发症发生率及全因死亡率的增加显著相关。GOLD认为，此类人群是发生慢性阻塞性肺疾病（chronic obstructive pulmonary di-sease，COPD）的高危人群，其中尤其需要关注以FVC下降为主的PRISm人群。2023版GOLD指出，即使患者未能符合COPD诊断标准，但由于其临床症状、肺功能减损和（或）支气管肺泡结构异常，应将PRISm患者视作COPD患者，进行PRISm早期筛查、规范化的治疗和管理。未来我国亟需开展大样本、多中心、长期随访的相关队列研究。

关键词: 一秒率保留, 慢性阻塞性肺疾病, 疾病管理, 全球倡议

Abstract:

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2023 first proposed “Preserved Ratio Impaired Spirometry (PRISm)”, which is the ratio of post-bronchodilator forced expiratory volume in one second to forced vital capacity is normal (FEV1/FVC ≥ 0.7) as pulmonary ventilation function is impaired (post-bronchodilator FEV1% and/ or FVC%<80%. It is particularly necessary to pay attention to the PRISm population with significant FVC deterioration. PRISm was associated with increased incidence of complications and all-cause mortality in the patients with in chronic obstructive pulmonary disease (COPD). In GOLD 2023, it was clarified that PRISm patients should be considered as COPD patients for early screening, standardized treatment, due to their significant clinical symptoms, lung function deterioration, and or abnormal bronchoalveolar structure even if their airway limitation does not meet the criteria for COPD. The cohort studies for large sample, multi-center, long-term follow-up with PRISm in China should be investigated in future.

Key words: Preserved ratio impaired, Chronic obstructive pulmonary disease, Disease management, Global initiative

中图分类号:

R563

孙娴雯, 李庆云. 关注保留比率的肺功能减损（PRISm）的慢性阻塞性肺疾病表型[J]. 诊断学理论与实践, 2023, 22(03): 234-237.

SUN Xianwen, LI Qingyun. Phenotypes of chronic obstructive pulmonary disease with preserved ratio impaired spirometry (PRISm)[J]. Journal of Diagnostics Concepts & Practice, 2023, 22(03): 234-237.

参考文献 18

[1]	Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease[R/OL]. https://goldcopd.org/2023-gold-report-2/.
[2]	WAN E S, HOKANSON J E, MURPHY J R, et al. Clinical and radiographic predictors of GOLD-unclassified smokers in the COPDGene study[J]. Am J Respir Crit Care Med, 2011, 184(1):57-63. doi: 10.1164/rccm.201101-0021OC URL
[3]	HAN M K, AGUSTI A, CELLI B R, et al. From GOLD 0 to Pre-COPD[J]. Am J Respir Crit Care Med, 2021, 203(4):414-423. doi: 10.1164/rccm.202008-3328PP URL
[4]	MARTINEZ F J, AGUSTI A, CELLI B R, et al. Treatment Trials in young patients with chronic obstructive pulmonary disease and pre-chronic obstructive pulmonary disease patients: time to move forward[J]. Am J Respir Crit Care Med, 2022, 205(3):275-287. doi: 10.1164/rccm.202107-1663SO URL
[5]	WAN E S, HOKANSON J E, REGAN E A, et al. Significant spirometric transitions and preserved ratio impaired spirometry among ever smokers[J]. Chest, 2022, 161(3):651-661. doi: 10.1016/j.chest.2021.09.021 URL
[6]	WAN E S, FORTIS S, REGAN E A, et al. Longitudinal phenotypes and mortality in preserved ratio impaired spirometry in the COPD gene study[J]. Am J Respir Crit Care Med, 2018, 198(11):1397-1405. doi: 10.1164/rccm.201804-0663OC URL
[7]	LITTLETON S W, TULAIMAT A. The effects of obesity on lung volumes and oxygenation[J]. Respir Med, 2017, 124:15-20. doi: S0954-6111(17)30004-5 pmid: 28284316
[8]	LEONE N, COURBON D, THOMAS F, et al. Lung function impairment and metabolic syndrome: the critical role of abdominal obesity[J]. Am J Respir Crit Care Med, 2009, 179(6):509-516. doi: 10.1164/rccm.200807-1195OC URL
[9]	WIJNANT S R A, DE ROOS E, KAVOUSI M, et al. Trajectory and mortality of preserved ratio impaired spirome-try: the Rotterdam Study[J]. Eur Respir J, 2020, 55(1):1901217. doi: 10.1183/13993003.01217-2019 URL
[10]	HIGBEE D H, GRANELL R, DAVEY SMITH G, et al. Prevalence, risk factors, and clinical implications of preserved ratio impaired spirometry: a UK Biobank cohort analysis[J]. Lancet Respir Med, 2022, 10(2):149-157. doi: 10.1016/S2213-2600(21)00369-6 URL
[11]	SCHWARTZ A, ARNOLD N, SKINNER B, et al. Preserved Ratio Impaired Spirometry in a Spirometry Database[J]. Respir Care, 2021, 66(1):58-65. doi: 10.4187/respcare.07712 pmid: 32873751
[12]	PARK H J, BYUN M K, RHEE C K, et al. Significant predictors of medically diagnosed chronic obstructive pulmonary disease in patients with preserved ratio impaired spirometry: a 3-year cohort study[J]. Respir Res, 2018, 19(1):185. doi: 10.1186/s12931-018-0896-7
[13]	WEI X, DING Q, YU N, et al. Imaging features of chronic bronchitis with preserved ratio and impaired spirometry (PRISm)[J]. Lung, 2018, 196(6):649-658. doi: 10.1007/s00408-018-0162-2 pmid: 30218155
[14]	WAN E S, BALTE P, SCHWARTZ J E, et al. Association Between Preserved Ratio Impaired Spirometry and Clinical Outcomes in US Adults[J]. JAMA, 2021, 326(22):2287-2298. doi: 10.1001/jama.2021.20939 pmid: 34905031
[15]	KIM J, LEE C H, LEE H Y, et al. Association between comorbidities and preserved ratio impaired spirometry: using the Korean National Health and Nutrition Examination Survey Ⅳ-Ⅵ[J]. Respiration, 2022, 101(1):25-33. doi: 10.1159/000517599 URL
[16]	WASHIO Y, SAKATA S, FUKUYAMA S, et al. Risks of mortality and airflow limitation in Japanese individuals with preserved ratio impaired spirometry[J]. Am J Respir Crit Care Med, 2022, 206(5):563-572. doi: 10.1164/rccm.202110-2302OC URL
[17]	BUI D S, LODGE C J, BURGESS J A, et al. Childhood predictors of lung function trajectories and future COPD risk: a prospective cohort study from the first to the sixth decade of life[J]. Lancet Respir Med, 2018, 6(7):535-544. doi: 10.1016/S2213-2600(18)30100-0 pmid: 29628376
[18]	HAN M K, YE W, WANG D, et al. Bronchodilators in tobacco-exposed persons with symptoms and preserved lung function[J]. N Engl J Med, 2022, 387(13):1173-1184. doi: 10.1056/NEJMoa2204752 URL

关注保留比率的肺功能减损（PRISm）的慢性阻塞性肺疾病表型

Phenotypes of chronic obstructive pulmonary disease with preserved ratio impaired spirometry (PRISm)

RichHTML

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献 18

相关文章 15

编辑推荐

Metrics

本文评价

[1]	孙娴雯, 李庆云. 新型冠状病毒疫情时期的慢性阻塞性肺疾病管理策略——2022版慢性阻塞性肺疾病全球倡议解读[J]. 诊断学理论与实践, 2022, 21(01): 32-37.
[2]	李庆云, 孙娴雯. 慢性阻塞性肺疾病稳定期管理的几个新视点：2021版 GOLD指南解读[J]. 诊断学理论与实践, 2021, 20(01): 43-47.
[3]	李庆云, 孙娴雯. 细化稳定期COPD管理流程和随访策略：2020版GOLD指南解读[J]. 诊断学理论与实践, 2020, 19(04): 354-358.
[4]	陈宇清, 王铭杰, 朱东, 吕城坚, 陈萍. 稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病患者的气道阻力对呼出气流受限的影响分析[J]. 诊断学理论与实践, 2019, 18(04): 418-422.
[5]	周敏, 张秋蕊. 呼吸道、肠道微生物菌群对慢性阻塞性肺疾病的发病及治疗的影响[J]. 诊断学理论与实践, 2019, 18(03): 246-249.
[6]	李媛媛, 张舒, 曹波, 陆晓晔, 刘黎, 陈杰, 归茜, 徐欣晖, 吕利雄, 朱长清,. 几种感染性疾病中外周血T淋巴细胞亚群变化的检测及其临床意义研究[J]. 诊断学理论与实践, 2015, 14(04): 363-366.
[7]	李庆云, 过依,. 慢性阻塞性肺疾病急性加重评估及稳定期用药选择:慢性阻塞性肺疾病全球倡议2015解读[J]. 诊断学理论与实践, 2015, 14(03): 215-218.
[8]	陈宇清, 吕成坚, 周新, 朱东,. 合并限制性通气功能障碍对稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病患者运动能力的影响[J]. 诊断学理论与实践, 2012, 11(04): 387-390.
[9]	邓伟吾,. 丙型肝炎病毒感染与慢性呼吸道疾病关系的认识[J]. 诊断学理论与实践, 2011, 10(05): 397-400.
[10]	马冠华, 杨昆, 李敏, 叶亮, 万欢英,. 呼吸道合胞病毒感染对慢性阻塞性肺疾病急性加重期患者的影响[J]. 诊断学理论与实践, 2010, 9(05): 503-506.
[11]	梁丽, 马佳韵, 李庆云, 陈振和, 周敏,. 慢性阻塞性肺疾病合并阻塞性睡眠呼吸暂停低通气综合征的临床特征[J]. 诊断学理论与实践, 2009, 8(06): 612-615.
[12]	陈宇清, 周新, 朱东, 戴晓敏,. 稳定期Ⅱ、Ⅲ级慢性阻塞性肺疾病患者的吸气分数与呼吸肌力研究[J]. 诊断学理论与实践, 2007, 6(05): 409-411.
[13]	谢灿茂, 周宇麒,. 慢性阻塞性肺疾病急性加重的现代评价[J]. 诊断学理论与实践, 2006, 5(02): 106-108.
[14]	秦慧, 李燕芹, 刘斌, 赵旭霁, 查琼芳, 邹静, 陈燕,. 呼气负压技术检测呼气流速受限在慢性阻塞性肺疾病中的应用[J]. 诊断学理论与实践, 2006, 5(02): 116-119.
[15]	余健民,. 趋化因子和细胞黏附分子在呼吸系统疾病诊断中的应用[J]. 诊断学理论与实践, 2006, 5(02): 109-112.