探讨五次坐立试验(five-time chair stand test, CST)表现与中老年新发慢性肺部疾病(chronic lung disease, CLD)风险的关联及在社区人群早期风险识别中的临床意义。

采用中国健康与养老追踪调查(China Health and Retirement Longitudinal Study, CHARLS)数据库，选择2011年基线调查及2013、2015、2018、2020年随访，年龄≥45岁、基线未报告CLD且关键变量完整参与者10 371例。根据CST分为异常组4 668例(男CST>7.5 s，女CST>9.5 s)，正常组5 703例(男CST≤7.5 s，女CST≤9.5 s)。采用Kaplan-Meier法和Log-rank检验比较两组CLD累积发生风险，构建Cox比例风险模型估计风险比(hazard ratio, HR)及95%置信区间(confidence interval, CI)。

随访期间10 371例参与者中1 601例新发CLD，其中异常组870例(18.64%)、正常组731例(12.82%)。异常组较正常组年龄，女性、农村居民、未婚及低教育水平者占比、高血压、糖尿病、心脏病、卒中及相关用药比例高(P<0.05)。受试者工作特征曲线(receiver operating characteristic, ROC)分析显示，男性CST预测新发CLD的曲线下面积(area under the curve, AUC)为0.588(95%CI：0.567~0.610)，最佳截断值7.5 s，灵敏度68.35%，特异度44.96%；女性AUC为0.583(95%CI：0.561~0.604)，最佳截断值9.5 s，灵敏度41.33%，特异度71.50%。Kaplan-Meier曲线显示，CST异常组无事件生存率低于正常组(Log-rank P<0.001)。Cox回归显示，未调整模型中CST异常与新发CLD风险升高相关(HR＝1.509，95%CI：1.368~1.665，P<0.001)；调整人口学因素、生活方式、共病及用药情况，关联稳定存在(HR＝1.559，95%CI：1.402~1.733，P<0.001)。

基线CST异常是中老年新发CLD风险增加的预测因子。对群体层面风险分层及社区早期识别具有临床意义。

To investigate the association between five-time chair stand test (CST) performance and the risk of incident chronic lung disease (CLD) in middle-aged and older adults, and to explore its clinical significance for early risk identification in community populations.

Data were obtained from the China Health and Retirement Longitudinal Study (CHARLS). A total of 10, 371 participants aged ≥45 years at baseline (2011) who were free of CLD and had complete data on key variables were included, with follow-up waves in 2013, 2015, 2018, and 2020. Participants were categorized into an abnormal CST group (n=4 668, male CST>7.5 s, female CST>9.5 s) and a normal CST group (n=5 703, male CST ≤7.5 s, female CST ≤9.5 s). Kaplan-Meier curves and log-rank tests were used to compare cumulative CLD incidence between groups, and Cox proportional hazards models were employed to estimate hazard ratios (HR) and 95% confidence intervals (CI).

During follow-up, 1, 601 out of 10, 371 participants developed incident CLD, including 870 cases (18.64%) in the abnormal CST group and 731 cases (12.82%) in the normal CST group. Compared with the normal group, the abnormal group was older and had higher proportions of females, rural residents, unmarried individuals, those with lower educational levels, and those with hypertension, diabetes, heart disease, stroke, and related medication use (all P<0.05). Receiver operating characteristic (ROC) analysis showed that for males, the area under the curve (AUC) of CST for predicting incident CLD was 0.588 (95%CI: 0.567~0.610), with an optimal cut-off value of 7.5 s, sensitivity of 68.35%, and specificity of 44.96%; for females, the AUC was 0.583 (95%CI: 0.561~0.604), with an optimal cut-off value of 9.5 s, sensitivity of 41.33%, and specificity of 71.50%. Kaplan-Meier curves demonstrated that the abnormal CST group had a significantly lower event-free survival rate than the normal group (log-rank P<0.001). Cox regression showed that in the unadjusted model, abnormal CST was associated with an increased risk of incident CLD (HR=1.509, 95%CI: 1.368~1.665, P<0.001); after adjusting for demographic factors, lifestyle, comorbidities, and medication use, the association remained robust (HR=1.559, 95%CI: 1.402~1.733, P<0.001).

Baseline CST abnormality is a predictor of increased risk of incident CLD in middle-aged and older adults. It holds clinical significance for population-level risk stratification and early community-based identification.