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北京大学学报（医学版） ›› 2025, Vol. 57 ›› Issue (3): 537-544. doi: 10.19723/j.issn.1671-167X.2025.03.018

• 论著 • 上一篇    下一篇

慢性阻塞性肺疾病患者体力活动与死亡风险的前瞻性关联

张烁1, 兰勇兵1, 孙点剑一1,2,3, 裴培2, 杜怀东4, 陈君石5, 陈铮鸣4, 吕筠1,2,3,6, 李立明1,2,3, 余灿清1,2,3,*(), (代表中国慢性病前瞻性研究项目协作组)   

  1. 1. 北京大学公共卫生学院流行病与卫生统计学系, 北京 100191
    2. 北京大学公众健康与重大疫情防 控战略研究中心, 北京 100191
    3. 重大疾病流行病学教育部重点实验室(北京大学), 北京 100191
    4. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
    5. 国家食品安全风险评估中心, 北京 100022
    6. 北京大学血管稳态与重构全国重点实验室, 北京 100191
  • 收稿日期:2025-02-04 出版日期:2025-06-18 发布日期:2025-06-13
  • 通讯作者: 余灿清
  • 基金资助:
    四大慢病重大专项(2023ZD0510100); 国家自然科学基金(82192901); 国家自然科学基金(82192904); 国家自然科学基金(82192900); 国家自然科学基金(82388102); 英国Wellcome Trust(212946/Z/18/Z); 英国Wellcome Trust(202922/Z/16/Z); 英国Wellcome Trust(104085/Z/14/Z); 英国Wellcome Trust(088158/Z/09/Z); 香港Kadoorie Charitable基金

Prospective association between physical activity and mortality in patients with chronic obstructive pulmonary disease

Shuo ZHANG1, Yongbing LAN1, Dianjianyi SUN1,2,3, Pei PEI2, Huaidong DU4, Junshi CHEN5, Zhengming CHEN4, Jun LV1,2,3,6, Liming LI1,2,3, Canqing YU1,2,3,*(), (for the China Kadoorie Biobank Collaborative Group)   

  1. 1. Department of Epidemiology & Biostatistics, Peking University School of Public Health, Beijing 100191, China
    2. Peking University Center for Public Health and Epidemic Preparedness & Response, Beijing 100191, China
    3. Key Laboratory of Epidemiology of Major Diseases (Peking University), Ministry of Education, Beijing 100191, China
    4. Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
    5. China National Center for Food Safety Risk Assessment, Beijing 100022, China
    6. State Key Laboratory of Vascular Homeostasis and Remodeling, Peking University, Beijing 100191, China
  • Received:2025-02-04 Online:2025-06-18 Published:2025-06-13
  • Contact: Canqing YU
  • Supported by:
    the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2023ZD0510100); National Natural Science Foundation of China(82192901); National Natural Science Foundation of China(82192904); National Natural Science Foundation of China(82192900); National Natural Science Foundation of China(82388102); Wellcome grants to Oxford University(212946/Z/18/Z); Wellcome grants to Oxford University(202922/Z/16/Z); Wellcome grants to Oxford University(104085/Z/14/Z); Wellcome grants to Oxford University(088158/Z/09/Z); Kadoorie Charitable Foundation in Hong Kong

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摘要：

目的: 探讨中国成人慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)患者体力活动水平与死亡风险的前瞻性关联。方法: 基于中国慢性病前瞻性研究(China Kadoorie Biobank, CKB)项目, 采用Cox比例风险回归模型分析中国成人COPD患者中总体力活动、不同强度(低、中高强度)及不同类型(工作、非工作)体力活动水平与全因死亡、主要死因死亡风险的前瞻性关联, 根据体力活动水平的五分位数分为5组(Q1~Q5), 将体力活动水平最低五分位数组(Q1)作为对照组, 计算其余各组(Q2~Q5)风险比(hazard ratio, HR)及其95%置信区间(confidence interval, CI), 同时实施了敏感性分析及亚组分析, 包括年龄、性别、自评健康状况、COPD严重程度等。结果: 基线时纳入33 588例COPD患者, 平均随访(11.1±3.1)年, 共记录到死亡8 314人(22.3%)。总体力活动水平与全因死亡、血管疾病及呼吸系统疾病死亡风险之间存在线性负相关(线性趋势检验P值依次为 < 0.001、0.002、 < 0.001), 与总体力活动水平最低五分位数组(Q1)相比, 最高五分位数组(Q5)对应的全因死亡、血管疾病及呼吸系统疾病死亡风险HR值(95%CI)分别为0.77 (0.70, 0.85)、0.77 (0.65, 0.91)、0.58 (0.48, 0.71)。低强度、中高强度体力活动均与COPD患者全因死亡风险存在线性负相关关联(线性趋势检验P值依次为0.002、 < 0.001), 与低强度、中高强度体力活动水平最低五分位数组(Q1)相比, 最高五分位数组(Q5)全因死亡风险对应的HR值(95%CI)分别为0.89 (0.82, 0.97)、0.79 (0.72, 0.87)。工作、非工作相关体力活动亦与COPD患者全因死亡风险存在线性负相关关联(线性趋势检验P值依次为 < 0.001、0.015), 与工作、非工作相关体力活动水平最低五分位数组(Q1)相比, 最高五分位数组(Q5)全因死亡风险对应的HR值(95%CI)分别为0.69 (0.61, 0.78), 0.91 (0.84, 0.98)。对于年龄≥60岁、女性、自评健康状况较差的人群, 总体力活动与全因死亡风险负相关性更为显著。对于不同严重程度的COPD患者, 随着总体力活动的增加, 全因死亡风险均呈下降趋势。结论: 总体力活动、不同强度、不同类别的体力活动均与COPD患者的死亡风险呈负相关, 且存在剂量反应关系。对于年龄≥60岁、女性、自评健康状况较差的人群, 总体力活动与全因死亡风险负相关性更为显著。

关键词: 慢性阻塞性肺疾病, 体力活动, 死亡, 前瞻性关联

Abstract:

Objective: To explore the prospective association between physical activity level and mortality risk in Chinese adults with chronic obstructive pulmonary disease (COPD). Methods: Based on the China Kadoorie Biobank (CKB) who had COPD at the baseline survey, this study employed the Cox proportional hazards regression model to estimate the prospective associations between the overall physical activity, different intensities (low-level, moderate-to-vigorous-level), and types (occupational, non-occupational) of physical activity level and the risks of all-cause and cause-specific mortality, such as vascular diseases, cancer, and respiratory diseases. Based on the quintiles of physical activity level, participants were divided into five groups (Q1-Q5), with the lowest quintile group (Q1) as the reference group. Hazard ratio (HR) and 95% confidence interval (95%CI) were calculated for the remaining. In our study, we also performed sensitivity and subgroup analyses, including age, gender, self-rated health status, severity of COPD, etc. Results: Among 33 588 COPD patients at the baseline survey, 8 314 (22.2%) deaths were documented during an average follow-up of (11.1±3.1) years. Negative linear associations between the overall physical activity level and mortality risk from all-cause, vascular, and respiratory diseases were observed (P trend for linear correlation being < 0.001, 0.002, < 0.001). Compared with the lowest quintile group of total physical activity (Q1), the hazard ratios (HR) and 95% confidence intervals (CI) for all-cause mortality, vascular disease mortality, and respiratory disease mortality in the highest quintile group (Q5) were 0.77 (0.70, 0.85), 0.77 (0.65, 0.91), and 0.58 (0.48, 0.71), respectively. The low-level and moderate-to-vigorous-level physical activity were negatively associated with all-cause mortality in the COPD patients (P trend for linear correlation: 0.002, < 0.001, respectively). Compared with the lowest quintile group of low-intensity and moderate-to-vigorous intensity physical activity (Q1), the HRs (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.89 (0.82, 0.97) and 0.79 (0.72, 0.87), respectively. The occupational and non-occupational physical activity were also found to have a linear inverse association with all-cause mortality risk among the COPD patients (P trend < 0.001 and 0.015, respectively). Compared with the lowest quintile group of occupational and non-occupational physical activity (Q1), the HR (95%CI) for all-cause mortality in the highest quintile group (Q5) were 0.69 (0.61, 0.78) and 0.91 (0.84, 0.98), respectively. The associations between overall physical activity and all-cause mortality risk were stronger for patients aged 60 and above, female, and who reported poor health status (P for interaction: 0.028, 0.012, 0.010). The protective effect of total physical activity was also applicable to the COPD patients of varying severity. Conclusion: Physical activity could reduce the mortality risk in a dose-response relationship among COPD patients, regardless of its intensity and type, especially among individuals aged 60 and above, females, and those with poor self-report health status.

Key words: Chronic obstructive pulmonary disease, Physical activity, Mortality, Prospective association

中图分类号: 

  • R184

表1

COPD患者的基线特征分布"

Characteristic Quintiles of total physical activity F/χ2 P
Q1 (n=6 774) Q2 (n=6 668) Q3 (n=6 731) Q4 (n=6 698) Q5 (n=6 717)
Age/years，${\bar x}$±s 64.4±8.8 61.6±9.7 58.1±10.5 55.0±10.3 52.0±9.5 1 746.7 < 0.001
Gender, n (%) 1 155.9 < 0.001
  Female 2 405 (35.5) 4 174 (62.6) 3 655 (54.3) 3 697 (55.2) 3 009 (44.8)
  Male 4 369 (64.5) 2 494 (37.4) 3 076 (45.7) 3 001 (44.8) 3 708 (55.2)
Area, n (%) 538.2 < 0.001
  Urban 3 069 (45.3) 2 714 (40.7) 2 275 (33.8) 1 842 (27.5) 2 317 (34.5)
  Rural 3 705 (54.7) 3 954 (59.3) 4 456 (66.2) 4 856 (72.5) 4 400 (65.5)
Married, n (%) 19.44 0.001
  Married 5 731 (84.6) 5 661 (84.9) 5 829 (86.6) 5 800 (86.6) 5 803 (86.4)
  Other 1 043 (15.4) 1 007 (15.1) 902 (13.4) 898 (13.4) 914 (13.6)
Education, n (%) 86.72 < 0.001
  Middle school and higher 2 249 (33.2) 2 174 (32.6) 2 214 (32.9) 2 043 (30.5) 1 840 (27.4)
  Primary school and lower 4 525 (66.8) 4 494 (67.4) 4 517 (67.1) 4 655 (69.5) 4 877 (72.6)
Household income, n (%) 55.75 < 0.001
  ≥20 000 yuan/year 2 113 (31.2) 2 274 (34.1) 2 430 (36.1) 2 197 (32.8) 2 230 (33.2)
   < 20 000 yuan/year 4 661 (68.8) 4 394 (65.9) 4 301 (63.9) 4 501 (67.2) 4 487 (66.8)
Occupation, n (%) 3 949.37 < 0.001
  Agriculture and industrial 2 174 (32.1) 2 634 (39.5) 4 146 (61.6) 4 930 (73.6) 5 145 (76.6)
  Other occupation 4 600 (67.9) 4 034 (60.5) 2 585 (38.4) 1 768 (26.4) 1 572 (23.4)
Regular consumption of meat, n (%) 31.86 < 0.001
  ≥4 d/week 2 757 (40.7) 2 674 (40.1) 2 612 (38.8) 2 451 (36.6) 2 646 (39.4)
   < 4 d/week 4 017 (59.3) 3 994 (59.9) 4 119 (61.2) 4 247 (63.4) 4 071 (60.6)
Regular consumption of fresh vegetables, n (%) 12.81 0.012
  ≥4 d/week 6 672 (98.5) 6 588 (98.8) 6 643 (98.7) 6 571 (98.1) 6 616 (98.5)
   < 4 d/week 102 (1.5) 80 (1.2) 88 (1.3) 127 (1.9) 101 (1.5)
Regular consumption of fresh fruit, n (%) 104.56 < 0.001
  ≥4 d/week 1 531 (22.6) 1 607 (24.1) 1 602 (23.8) 1 326 (19.8) 1 209 (18.0)
   < 4 d/week 5 243 (77.4) 5 061 (75.9) 5 129 (76.2) 5 372 (80.2) 5 508 (82.0)
Drinking status, n (%) 52.19 < 0.001
  Current weekly drinker 2 683 (39.6) 2 627 (39.4) 2 706 (40.2) 2 693 (40.2) 2 821 (42.0)
  Non-current weekly drinker 4 091 (60.4) 4 041 (60.6) 4 025 (59.8) 4 005 (59.8) 3 896 (58.0)
Smoking status, n (%) 18.58 0.001
  Current daily smoker 1 009 (14.9) 1 014 (15.2) 1 198 (17.8) 1 192 (17.8) 1 243 (18.5)
  Non-current smoker 5 765 (85.1) 5 654 (84.8) 5 533 (82.2) 5 506 (82.2) 5 474 (81.5)
BMI/(kg/m2)，${\bar x}$±s 22.8±3.8 22.8±3.7 22.8±3.5 22.5±3.4 22.5±3.2 10.65 < 0.001
Sedentary/ (h/d)，${\bar x}$±s 3.5±2.0 3.5±1.8 3.1±1.6 2.7±1.5 2.5±1.4 390.75 < 0.001
GOLD, n (%) 456.27 < 0.001
  1 1 687 (24.9) 1 840 (27.6) 2 006 (29.8) 1 942 (29.0) 2 042 (30.4)
  2 3 184 (47.0) 3 194 (47.9) 3 150 (46.8) 3 275 (48.9) 3 379 (50.3)
  3 1 429 (21.1) 1 300 (19.5) 1 292 (19.2) 1 233 (18.4) 1 101 (16.4)
  4 474 (7.0) 334 (5.0) 283 (4.2) 248 (3.7) 195 (2.9)
Self-assessed health status, n (%) 362.41 < 0.001
  Excellent 644 (9.5) 785 (11.8) 828 (12.3) 824 (12.3) 804 (11.9)
  Good 1 361 (20.1) 1 426 (21.4) 1 615 (24.0) 1 567 (23.4) 1 798 (26.8)
  Average 2 994 (44.2) 3 065 (45.9) 3 110 (46.2) 3 182 (47.5) 3 054 (45.5)
  Poor 1 775 (26.2) 1 392 (20.9) 1 178 (17.5) 1 125 (16.8) 1 061 (15.8)
Coronary heart disease, n (%) 46.98 < 0.001
  Yes 318 (4.7) 280 (4.2) 269 (4.0) 174 (2.6) 154 (2.3)
  No 6 456 (95.3) 6 388 (95.8) 6 462 (96.0) 6 524 (97.4) 6 563 (97.7)
Diabetes, n (%) 62.14 < 0.001
  Yes 271 (4.0) 240 (3.6) 168 (2.5) 147 (2.2) 114 (1.7)
  No 6 503 (96.0) 6 428 (96.4) 6 563 (97.5) 6 551 (97.8) 6 603 (98.3)
Kidney disease, n (%) 14.35 0.006
  Yes 163 (2.4) 120 (1.8) 108 (1.6) 127 (1.9) 101 (1.5)
  No 6 611 (97.6) 6 548 (98.2) 6 623 (98.4) 6 571 (98.1) 6 616 (98.5)
Stroke, n (%) 101.74 < 0.001
  Yes 217 (3.2) 133 (2.0) 94 (1.4) 60 (0.9) 60 (0.9)
  No 6 557 (96.8) 6 535 (98.0) 6 637 (98.6) 6 638 (99.1) 6 657 (99.1)

表2

COPD患者中总体力活动与死亡风险的关联"

Quintiles of total physical activity P
Q1 Q2 Q3 Q4 Q5
All-cause mortality
  Number of deaths, n 2 764 1 955 1 558 1 195 842
  Mortality rate/% 40.4 26.8 20.5 15.5 10.6
  Model 1, HR(95%CI) 1.00 0.83 (0.78, 0.88) 0.76 (0.70, 0.81) 0.69 (0.63, 0.74) 0.63 (0.58, 0.69) < 0.001
  Model 2, HR(95%CI) 1.00 0.90 (0.84, 0.95) 0.85 (0.79, 0.91) 0.78 (0.72, 0.85) 0.77 (0.70, 0.85) < 0.001
Vascular disease mortality
  Number of deaths, n 1 069 749 506 372 244
  Mortality rate/% 15.6 10.3 6.7 4.8 3.1
  Model 1, HR(95%CI) 1.00 0.81 (0.74, 0.89) 0.75 (0.66, 0.84) 0.73 (0.63, 0.84) 0.66 (0.56, 0.77) < 0.001
  Model 2, HR(95%CI) 1.00 0.88 (0.80, 0.97) 0.83 (0.73, 0.93) 0.82 (0.71, 0.94) 0.77 (0.65, 0.91) 0.002
Malignant tumor mortality
  Number of deaths, n 619 470 383 327 287
  Mortality rate/% 9.1 6.4 5.1 4.2 3.6
  Model 1, HR(95%CI) 1.00 1.01 (0.90, 1.15) 0.91 (0.79, 1.05) 0.88 (0.75, 1.03) 0.88 (0.74, 1.04) 0.105
  Model 2, HR(95%CI) 1.00 1.03 (0.91, 1.16) 0.94 (0.82, 1.09) 0.91 (0.77, 1.08) 0.92 (0.78, 1.10) 0.293
Respiratory disease mortality
  Number of deaths, n 702 493 427 288 165
  Mortality rate/% 10.3 6.8 5.6 3.7 2.1
  Model 1, HR(95%CI) 1.00 0.74 (0.66, 0.83) 0.61 (0.53, 0.70) 0.45 (0.38, 0.53) 0.37 (0.31, 0.46) < 0.001
  Model 2, HR(95%CI) 1.00 0.86 (0.76, 0.97) 0.76 (0.66, 0.87) 0.58 (0.49, 0.69) 0.58 (0.48, 0.71) < 0.001

表3

COPD患者中总体力活动与全因死亡风险的亚组分析"

Quintiles of total physical activity P(LR χ2)
Q1 Q2 Q3 Q4 Q5
Age group/years 0.028 (7.12)
  30- 1.00 1.19 (0.76, 1.86) 1.06 (0.68, 1.65) 1.02 (0.66, 1.59) 1.15 (0.75, 1.77)
  50- 1.00 0.88 (0.73, 1.06) 0.86 (0.71, 1.04) 0.81 (0.67, 0.99) 0.81 (0.66, 0.99)
  60- 1.00 0.90 (0.84, 0.96) 0.85 (0.79, 0.92) 0.79 (0.72, 0.87) 0.77 (0.68, 0.86)
Area 0.125 (2.35)
  Rural 1.00 0.89 (0.83, 0.96) 0.85 (0.78, 0.92) 0.79 (0.72, 0.86) 0.75 (0.68, 0.83)
  Urban 1.00 0.93 (0.84, 1.04) 0.88 (0.77, 1.01) 0.80 (0.65, 0.97) 0.86 (0.70, 1.06)
Gender 0.012 (6.24)
  Male 1.00 0.90 (0.83, 0.97) 0.90 (0.82, 0.98) 0.83 (0.75, 0.92) 0.81 (0.73, 0.91)
  Female 1.00 0.86 (0.78, 0.95) 0.77 (0.68, 0.87) 0.67 (0.58, 0.77) 0.64 (0.53, 0.76)
Smoking status 0.109 (2.57)
  Non-current smoker 1.00 0.91 (0.83, 0.99) 0.82 (0.74, 0.92) 0.76 (0.67, 0.86) 0.71 (0.61, 0.82)
  Current daily smoker 1.00 0.88 (0.81, 0.96) 0.86 (0.78, 0.95) 0.79 (0.71, 0.88) 0.79 (0.70, 0.89)
Drinking status 0.004 (8.12)
  Non-current weekly drinker 1.00 0.92 (0.86, 0.98) 0.86 (0.80, 0.93) 0.78 (0.71, 0.85) 0.77 (0.69, 0.86)
  Current weekly drinker 1.00 0.74 (0.62, 0.87) 0.75 (0.63, 0.89) 0.74 (0.61, 0.89) 0.71 (0.58, 0.87)
Sedentary/(h/d) 0.158 (1.99)
   < 3 1.00 0.91 (0.82, 1.00) 0.83 (0.75, 0.93) 0.78 (0.68, 0.88) 0.75 (0.66, 0.86)
  ≥3 1.00 0.88 (0.81, 0.95) 0.85 (0.77, 0.93) 0.78 (0.70, 0.87) 0.78 (0.68, 0.89)
GOLD 0.016 (8.32)
  1 1.00 0.92 (0.78, 1.09) 0.84 (0.69, 1.03) 0.76 (0.60, 0.95) 0.76 (0.60, 0.97)
  2 1.00 0.95 (0.87, 1.04) 0.95 (0.85, 1.06) 0.91 (0.81, 1.04) 0.87 (0.76, 1.00)
  3-4 1.00 0.82 (0.75, 0.90) 0.74 (0.66, 0.82) 0.66 (0.58, 0.74) 0.64 (0.55, 0.75)
BMI/(kg/m2) 0.003 (14.30)
  Underweight 1.00 0.86 (0.75, 0.99) 0.78 (0.66, 0.92) 0.64 (0.53, 0.78) 0.57 (0.45, 0.71)
  Normal weight 1.00 0.88 (0.81, 0.95) 0.80 (0.73, 0.89) 0.73 (0.65, 0.81) 0.71 (0.63, 0.80)
  Overweight 1.00 0.86 (0.75, 0.98) 0.81 (0.69, 0.96) 0.91 (0.75, 1.11) 0.77 (0.61, 0.96)
  Obese 1.00 1.02 (0.78, 1.33) 1.08 (0.81, 1.44) 0.60 (0.39, 0.91) 0.80 (0.49, 1.32)
Self-assessed health status 0.010 (11.34)
  Excellent 1.00 0.99 (0.78, 1.24) 0.91 (0.69, 1.20) 0.90 (0.65, 1.23) 0.95 (0.68, 1.33)
  Good 1.00 0.87 (0.75, 1.02) 0.82 (0.69, 0.98) 0.78 (0.64, 0.95) 0.70 (0.57, 0.86)
  Average 1.00 0.87 (0.80, 0.95) 0.87 (0.78, 0.96) 0.78 (0.69, 0.88) 0.73 (0.63, 0.84)
  Poor 1.00 0.85 (0.76, 0.95) 0.71 (0.62, 0.81) 0.61 (0.53, 0.71) 0.58 (0.48, 0.71)

图1

COPD患者不同强度体力活动与全因死亡风险的关联"

图2

COPD患者不同类型体力活动与全因死亡风险的关联"

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