The concept, estimation and application of lung age
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摘要: 肺龄指通过年龄来量化肺的生理功能水平，最初用于评估吸烟对肺功能的损害程度。肺龄主要通过基于肺量计检查指标建立的肺龄预计值公式来估算，肺龄预计值公式的建立方法分为直接通过肺量计指标预计值公式反推和基于大样本正常人群数据的多元回归分析2种方法。目前共有6项研究建立了基于不同国家和地区(美国1985年、澳大利亚2010年、美国2010年、日本2012年、北非2014年、日本2015年)人群数据的肺龄预计值公式，但这些研究在研究设计、样本量、目标人群、统计方法等方面都各自存在着一些缺陷。在肺龄的应用方面，研究发现告知肺龄可激励吸烟者戒烟；肺龄是食管癌切除术和非小细胞肺癌切除术术后并发症发生的独立预测因子；肺龄可用于评估哮喘患者使用雷曲珠单抗治疗的疗效；肺龄诊断肺通气功能障碍具有较好的敏感性和特异性。此外，研究还发现肺龄与肥胖、呼吸困难、吸烟、慢阻肺病史、哮喘病史、年龄和身高等因素相关。肺龄虽然无法提供肺量计检查反映的全部信息，但作为肺量计检查结果的一个简化形式，肺龄更易于患者理解其肺功能水平和疾病严重程度，因此或可成为慢性呼吸系统疾病防治和管理的有效工具，尤其适合于基层医疗机构及全科医师的应用和推广。本文介绍了肺龄的概念、估算方法和临床应用，并对肺龄的应用前景提出了建议。Abstract: Lung age is a term that uses effective age to quantify the physiological function of lung. It was firstly proposed to evaluate the lung function impairment caused by smoking. Estimation of lung age can be derived from the lung age predictive equation based on spirometric indices. The predictive equation of lung age can be developed by the rearrangement of the predictive equations of spirometric indices, or the multiple regression analysis based on large data of healthy population. Six studies have developed predictive equations of lung age based on date from different countries (America in 1985, Australia in 2010, America in 2010, Japan in 2012, North Africa in 2014, Japan in 2015). However, limitations in study design, sample size, population source and statistical analysis are shown in these six studies. As for the application of lung age, studies show that lung age may motivate smoking cessation. Lung age is the independent predictor of complications after esophagectomy and the surgery for non-small cell lung cancer, it can be used in the assessment of the treatment efficacy of Reslizumab in asthmatic patients, and it has good sensitivity and specificity in diagnosing lung function dysfunction. Also, lung age is shown to be related to obesity, dyspnea, smoking, chronic obstructive pulmonary disease, asthma, age and height. As a simplification of spirometry results, although lung age cannot offer the complete information of spirometry, it can be easily understood by general public and be implemented by the health care providers, which enables lung age to be a useful tool in the prevention and management of chronic respiratory diseases. It is especially suitable for the application and promotion of primary medical institutions and general practitioners. The present review introduced the concept, estimation and clinical application of lung age, and proposed suggestions about the prospect of lung age.
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Key words:
- Lung age /
- Lung function tests /
- Smoking cessation
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表 1 肺龄已有公式汇总
文献 性别 肺龄公式 MORRIS J F等[8]，1985，美国 男 SLA(Yrs)=1.130×H(cm)-31.250×FEV1(L)-39.375 女 SLA(Yrs)=1.401×H(cm)-40.000×FEV1(L)-77.280 HANSEN J E等[11]，2010，美国 男 SLA(Yrs)=CA(Yrs)+3 ×(预计FEV1/FVC%-实测FEV1/FVC%) 女 SLA(Yrs)=CA(Yrs)+3 ×(预计FEV1/FVC%-实测FEV1/FVC%) NEWBURY W等，2010[10]，澳大利亚 男 SLA(Yrs)=1.56×H(cm)-33.69×FEV1(L)-85.62 女 SLA(Yrs)=1.33×H(cm)-31.98×FEV1(L)-74.65 YAMAGUCHI K等[12]，2012，日本 男 SLA(Yrs)=209.195-0.455×H(cm)-11.521×FEV1(L)-0.602×FEV1/FVC(%)+1.956×FEF50(L/s) 女 SLA(Yrs)=234.441-0.792×H(cm)-7.295×FEV1(L)-0.610×FEV1/FVC(%)+0.301×PEF(L/s)+2.647×FEF50(L/s) BEN SAAD H等[13]，2014，北非 男 SLA(Yrs)=42.85-20.74×FEV1(L)+47.41×BSA(m2)-0.62×BMI 女 SLA(Yrs)=64.64-8.00×FEV1(L)-0.17×BMI+0.09×H(cm) ISHIDA Y等[14]，2015，日本 男 SLA(Yrs)=1.00×FVC(%)-33.3×FEV1(L)+50.7 女 SLA(Yrs)=0.84×FVC(%)-40×FEV1(L)+50.2 注：BMI为体重指数；BSA为体表面积；CA为真实年龄；H为身高；FEV1为第一秒用力呼气容积；FVC为用力肺活量；FEF50为呼出50%用力肺活量时的呼气流量；PEF为呼气峰值流量；SLA为基于肺量计指标计算的肺龄。 
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表 2 肺龄公式的特征概述
作者 样本量 主要指标 优点 不足之处 MORRIS J F等[8] 988 FEV1、身高 首次提出肺龄概念及估算公式 使用肺量计预计值公式反推法产生肺龄公式，且公式是基于至今47年的数据 HANSEN J E等[11] 7 428 实际年龄、FEV1/FVC 包含白人、黑人及拉丁裔者数据 使用肺量计预计值公式反推法产生肺龄公式，且公式是基于至今超过25年的数据 NEWBURY W等[10] 125 FEV1、身高 受试者年龄分层较均匀 样本量过小 YAMAGUCHI K等[12] 8 015 FEV1、FEV1/FVC、PEF、FEF50、身高 首次使用多元回归方程建立肺龄公式，并提供肺龄的正常参考范围和解读方法 BEN SAAD H等[13] 540 FEV1、身高、BMI、BSA 25%受试者属于中度肥胖 ISHIDA Y等[14] 15 238 FEV1、FVC 样本量大；受试者年龄分层较均匀 基于高收入职业人群数据；使用肺量计预计值公式反推法产生肺龄公式
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