[Impact of the high-altitude environment on preserved ratio impaired spirometry and its underlying mechanisms].

Preserved ratio impaired spirometry (PRISm) is an intermediate phenotype between normal lung function and chronic obstructive pulmonary disease (COPD), and it carries a high risk of progressing to COPD. Due to unique factors such as hypobaric hypoxia, the detection rate of PRISm is significantly higher in high-altitude environments than in plain areas. High-altitude hypoxia may contribute to the development and progression of PRISm through multiple mechanisms, including induction of systemic inflammatory responses, oxidative stress injury, abnormal activation of hypoxia-inducible factor (HIF) signaling pathways, and an increased cardiopulmonary compensatory burden. However, direct evidence regarding the specific mechanisms involved still requires further investigation. Unique risk factors for PRISm in high-altitude regions include elevated white blood cell count, elevated red blood cell distribution width, and a history of tuberculosis. Current research on PRISm at high altitude faces challenges including a lack of diagnostic criteria, insufficient epidemiological data, and limited mechanistic exploration. Future efforts should focus on establishing altitude-specific reference values for lung function, conducting multicenter longitudinal cohort studies and multi-omics mechanistic research, developing appropriate screening and intervention tools, promoting interdisciplinary collaboration, and improving the comprehensive prevention and control system for PRISm in high-altitude regions.