Clinical Phenotypes of Nasal Polyps and Comorbid Asthma Based on Cluster Analysis of Disease History.
Clinical Phenotypes of Nasal Polyps and Comorbid Asthma Based on Cluster Analysis of Disease History.
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DOI：
10.1016/j.jaip.2017.09.020
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发表时间：
2017-10
期刊：
影响因子：
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通讯作者：
Dawei Wu;B. Bleier;Lun Li;X. Zhan;Lichuan Zhang;Qian-wen Lv;Jianting Wang;Yongxiang Wei
中科院分区：
文献类型：
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作者：
Dawei Wu;B. Bleier;Lun Li;X. Zhan;Lichuan Zhang;Qian-wen Lv;Jianting Wang;Yongxiang Wei
背景鼻息肉和共病哮喘（NPcA）是一种常见的联合气道疾病，在临床、生理和病理参数方面具有高度异质性。对NPcA的临床表型了解甚少。目的我们试图探讨NPcA患者的临床表型。方法从鼻科诊所和呼吸科诊所招募首次诊断为NPcA的患者。我们根据自然病程和人口特征的参数对 NPcA 患者进行聚类。还对患者上呼吸道和下呼吸道的临床、功能和炎症参数进行了评估。 结果 110 例病例分为 3 个聚类：聚类 1（n = 16，14.55%，特应性 NPcA）主要是具有儿童发病气道症状、病程中等、有家族哮喘病史、肺功能较好且哮喘不太严重的特应性患者；第 2 组（n = 32，29.09%，吸烟 NPcA）的特点是吸烟者较多、病程较短、成人发病的气道症状、过敏性较低、非甾体类抗炎药敏感性、既往鼻窦手术史、嗜酸性气道表型、肺功能较差和严重的计算机断层扫描表现；第 3 组（n = 62，56.36%，老年 NPcA）主要由病程较长、成人发病的气道症状、特应性较少、非嗜酸性粒细胞气道表型较多以及既往有鼻窦手术史的老年患者组成。 结论 具有 3 个不同自然病程的 NPcA 患者具有不同的炎症状态和疾病严重程度。确定患者的自然病程可能有助于临床医生预测 NPcA 的临床情况，并有助于未来以表型为指导的管理方法。
BackgroundNasal polyps and comorbid asthma (NPcA) is a common united airway disease and is highly heterogeneous with respect to clinical, physiologic, and pathologic parameters. The clinical phenotypes of NPcA are poorly understood.ObjectiveWe sought to explore clinical phenotypes in patients with NPcA.MethodsPatients first diagnosed with NPcA were recruited from Rhinological Clinics and Respiratory Clinics. We clustered patients with NPcA based on parameters regarding natural courses and demographic characteristics. Patients were also evaluated with respect to clinical, functional, and inflammatory parameters in both upper and lower airways.ResultsClustering of 110 cases resulted in 3 clusters: cluster 1 (n = 16, 14.55%, atopic NPcA) was predominantly atopic patients with child-onset airway symptoms, intermediate disease duration, history of family asthma, better lung function, and less severe asthma; cluster 2 (n = 32, 29.09%, smoking NPcA) was characterized by more smokers, short disease duration, adult-onset airway symptoms, less atopy, nonsteroidal anti-inflammatory drug sensitivity, prior sinus surgery history, eosinophilic airway phenotypes, worse lung function, and severe computed tomography appearance; and cluster 3 (n = 62, 56.36%, older NPcA) consisted mostly of older patients with long disease duration, adult-onset airway symptoms, less atopy, more noneosinophilic airway phenotypes, and prior sinus surgery history.ConclusionsPatients with NPcA with 3 distinct natural courses had different inflammatory status and disease severity. Determining the natural course of a patient might help clinicians predict the clinical aspects of NPcA and contribute to phenotype-guided management approaches in the future.