中国成年人气流受限与主要慢性病发病风险的前瞻性关联分析

Associations between airflow obstruction and the risks of morbidity on major chronic diseases in Chinese adults： a prospective cohort study

目的在中国成年人中探究气流受限与主要慢性病发病风险的前瞻性关联。方法本研究基于中国慢性病前瞻性研究，剔除基线自报患有心脏病、脑卒中和恶性肿瘤的个体后，共纳入基线时30~79岁（平均51.5岁）的研究对象486 996名。分别以慢性阻塞性肺疾病全球倡议（GOLD）标准和第一秒用力呼气容积占预计值百分比（FEV1%P）评价气流受限，使用Cox比例风险回归模型分析气流受限与缺血性心脏病、脑血管病和肺癌发病之间的关联。结果在平均7年的随访期间，缺血性心脏病、脑血管病、肺癌分别新发24 644、36 336、3 218例。与气流正常者相比，GOLD-1至GOLD-4人群的缺血性心脏病发病风险比（HR）值（95%CI）依次为0.89（0.78~1.01）、1.05（0.98~1.12）、1.29（1.18~1.40）和1.65（1.42~1.91）；肺癌发病HR值（95%CI）依次为0.96（0.70~1.26）、1.12（0.96~1.31）、1.38（1.14~1.65）和1.48（1.05~2.02）。未发现GOLD分级与脑血管病发病风险之间存在有统计学意义的关联。FEV1%P每下降10%，缺血性心脏病、脑血管病、肺癌风险分别增加7.2%（95%CI：6.4%~8.0%）、3.6%（95%CI：3.0%~4.3%）、10.5%（95%CI：8.4%~12.6%）。按吸烟状态分层分析，上述结果基本不变。结论我国成年人群中气流受限程度越严重，个体缺血性心脏病、脑血管病和肺癌的发病风险越高。

Objective To examine the prospective associations between airflow obstruction （AFO） and risks of major chronic diseases morbidity in Chinese adults.Methods Samples of this study were from the China Kadoorie Biobank. A total of 486 996 participants aged 30 to 79 years （mean 51.5 years） at the baseline study, were included after excluding those who self-reported of having heart disease, stroke and cancer at baseline. AFO was defined under the Global Initiative on Obstructive Lung Disease （GOLD） criteria and forced expiratory volume per one second in percentage of the expected one （FEV1% P）. Cox regression models were used to investigate the associations of AFO with incidence rates of ischemic heart disease, cerebrovascular disease and lung cancer after adjusted for potential confounders. Results Over a period of 7 years through the follow-up program, the incident cases of ischemic heart disease, cerebrovascular disease and lung cancer appeared as 24 644, 36 336 and 3 218, respectively. Compared with people without AFO, the HR （95% CI） of GOLD-1 to GOLD-4 were 0.89 （0.78-1.01）, 1.05 （0.98-1.12）, 1.29 （1.18-1.40） and 1.65 （1.42-1.91） respectively for ischemic heart disease. The HR （95%CI） of GOLD-1 to GOLD-4 were 0.96 （0.70-1.26）, 1.12 （0.96-1.31）, 1.38 （1.14-1.65） and 1.48 （1.05-2.02） respectively for lung cancer. No statistically significant differences in the associations between GOLD level and cerebrovascular disease morbidity were found. However, each 10% decrease in FEV1% P was associated with 7.2% （95%CI： 6.4%-8.0%）, 3.6% （95%CI： 3.0%-4.3%） and 10.5% （95%CI： 8.4%-12.6%） increased the risks of ischemic heart disease, cerebrovascular disease and lung cancer respectively. The results were persistant when stratified by smoking status.Conclusion Higher degree of AFO seemed to be associated with the risks of ischemic heart disease, cerebrovascular disease and lung cancer morbidity among the Chinese adults.