The Inflammation-Metabolism Axis in Preserved Ratio Impaired Spirometry: Pathogenic Mechanisms and Translational Implications.

Preserved Ratio Impaired Spirometry (PRISm) is a spirometric phenotype characterized by a FEV1/FVC ratio ≥ 0.7 and FEV1 < 80% of the predicted value. It is significantly associated with increased all-cause mortality and the risk of various diseases. However, its underlying pathophysiological mechanisms remain incompletely understood. By synthesizing evidence from epidemiological and mechanistic studies, this review proposes the "inflammatory-metabolic axis" as the central pathogenic mechanism driving PRISm. This theoretical framework posits that inflammaging establishes a pro-inflammatory substrate, which, upon amplification by exogenous stimuli, culminates in a self-sustaining chronic inflammatory network. Concurrently, metabolic dysfunction interacts synergistically with inflammatory processes via pro-oxidative mechanisms and dysregulated adipokine signaling. PRISm thus represents an early functional pulmonary manifestation of systemic inflammatory-metabolic dysregulation. This review underscores that targeting inflammatory-metabolic interactions offers a promising translational avenue for the early identification and intervention of PRISm.