Preserved ratio impaired spirometry (PRISm) is a heterogeneous condition but its course and disease progression remain to be elucidated. We aimed to examine its prevalence, trajectories and prognosis in the general population. In the Rotterdam Study (population-based prospective cohort) we examined prevalence, trajectories and prognosis of subjects with normal spirometry (controls; forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7, FEV1 ≥80%), PRISm (FEV1/FVC ≥0.7, FEV1 <80%) and chronic obstructive pulmonary disease (COPD) (FEV1/FVC <0.7) at two study visits. Hazard ratios with 95% confidence intervals for mortality (until December 30, 2018) were adjusted for age, sex, body mass index, current smoking and pack-years. Of 5487 subjects (age 69.1±8.9 years; 7.1% PRISm), 1603 were re-examined after 4.5 years. Of the re-examined PRISm subjects, 15.7% transitioned to normal spirometry and 49.4% to COPD. Median lung function decline was highest in subjects with incident PRISm (FEV1 −92.8 mL·year−1, interquartile range (IQR) −131.9– −65.8 mL·year−1; FVC −93.3 mL·year−1, IQR −159.8– −49.1 mL·year−1), but similar in persistent PRISm (FEV1 −30.2 mL·year−1, IQR −67.9– −7.5 mL·year−1; FVC −20.1 mL·year−1, IQR −47.7–21.7 mL·year−1) and persistent controls (FEV1 −39.6 mL·year−1, IQR −64.3–−12.7 mL·year−1; FVC −20.0 mL·year−1, IQR −55.4–18.8 mL·year−1). Of 5459 subjects with informed consent for follow-up, 692 (12.7%) died during 9.3 years (maximum) follow-up: 10.3% of controls, 18.7% of PRISm subjects and 20.8% of COPD subjects. Relative to controls, subjects with PRISm and COPD Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2–4 had increased all-cause mortality (PRISm: HR 1.6, 95% CI 1.2–2.0; COPD GOLD 2–4: HR 1.7, 95% CI 1.4–2.1) and cardiovascular mortality (PRISm: HR 2.8, 95% CI 1.5–5.1; COPD 2–4: HR 2.1, 95% CI 1.2–3.6). Mortality within <1 year was highest in PRISm, with patients often having cardiovascular comorbidities (heart failure or coronary heart disease; 70.0%). PRISm is associated with increased mortality and this population encompasses at least three distinct subsets: one that develops COPD during follow-up, a second with high cardiovascular burden and early mortality, and a third with persistent PRISm and normal age-related lung function decline. Preserved ratio impaired spirometry, previously called restrictive spirometry, is a condition associated with increased mortality that encompasses distinct clinical subsets http://bit.ly/2ncclac

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保留比率受损肺活量测定的轨迹和死亡率：鹿特丹研究

保留比率受损肺活量测定 (PRISm) 是一种异质性疾病，但其病程和疾病进展仍有待阐明。我们的目的是检查其在普通人群中的患病率、轨迹和预后。在鹿特丹研究（基于人群的前瞻性队列）中，我们检查了肺活量正常的受试者的患病率、轨迹和预后（对照；1 秒用力呼气量 (FEV1)/用力肺活量 (FVC) ≥0.7，FEV1 ≥80%） , PRISm (FEV1/FVC ≥0.7, FEV1 <80%) 和慢性阻塞性肺病 (COPD) (FEV1/FVC <0.7) 在两次研究访问中。针对年龄、性别、体重指数、当前吸烟和包装年数调整了死亡率为 95% 置信区间的风险比（截至 2018 年 12 月 30 日）。在 5487 名受试者中（年龄 69.1±8.9 岁；7.1% PRISM），4.5 年后重新检查了 1603 名。在重新检查的 PRISM 受试者中，15.7% 转换为正常肺活量测定，49.4% 转换为 COPD。发生 PRISm 的受试者中位肺功能下降最高（FEV1 -92.8 mL·year-1，四分位距 (IQR) -131.9– -65.8 mL·year-1；FVC​​ -93.3 mL·year-1，IQR -159.8– −49.1 mL·year−1)，但在持续性 PRISm 中相似（FEV1 −30.2 mL·year−1，IQR −67.9– -7.5 mL·year−1；FVC​​ −20.1 mL·year−1，IQR −47.7–21.7 mL·year-1) 和持续对照 (FEV1 -39.6 mL·year-1, IQR -64.3–-12.7 mL·year-1; FVC -20.0 mL·year-1, IQR -55.4–18.8 mL·year-1 ）。在 5459 名知情同意的受试者中，692 名（12.7%）在 9.3 年（最长）随访期间死亡：10.3% 的对照组、18.7% 的 PRISM 受试者和 20.8% 的 COPD 受试者。相对于控件，患有 PRISm 和 COPD 慢性阻塞性肺病全球倡议 (GOLD) 2-4 的受试者全因死亡率增加（PRISm：HR 1.6，95% CI 1.2-2.0；COPD GOLD 2-4：HR 1.7，95% CI 1.4 –2.1) 和心血管死亡率 (PRISm: HR 2.8, 95% CI 1.5–5.1; COPD 2–4: HR 2.1, 95% CI 1.2–3.6)。在 PRISm 中，<1 年内的死亡率最高，患者通常有心血管合并症（心力衰竭或冠心病；70.0%）。PRISm 与死亡率增加有关，该人群至少包含三个不同的亚群：一个在随访期间发展为 COPD，第二个具有高心血管负担和早期死亡率，第三个具有持续性 PRISm 和与年龄相关的正常肺功能下降。保留比率受损的肺量测定法，以前称为限制性肺量测定法，