Identification of a predominant COPD phenotype in clinical practice
Identification of a predominant COPD phenotype in clinical practice
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DOI：
10.1016/j.rmed.2007.10.019
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发表时间：
2008-03-01
影响因子：
4.3
通讯作者：
Giuntini, Carlo
中科院分区：
文献类型：
--
作者：
Pistolesi, Massimo;Camiciottoli, Gianna;Giuntini, Carlo
背景资料：慢性阻塞性肺疾病（COPD）的特征是由小气道阻力增加和/或终末气腔气肿性破坏引起的气流[模仿]。不完全可逆的气流限制的肺量测定检测在首字母缩写COPD下统一，COPD是一系列异质性疾病，其临床表现可能有很大不同。在一项横断面研究中，我们的目的是确定是否COPD表型反映不同的机制，气流限制可以在临床上identified.Methods：多维缩放被用来可视化作为一个单一的点，在一个二维空间的多维变量来自每个322 COPD患者（衍生集）的临床，功能和胸部放射学评价。然后，聚类分析为每个患者数据点分配聚类成员。最后，使用聚类隶属度作为因变量，所有获得的数据作为自变量，我们开发了多变量模型，对另一组93例COPD患者进行前瞻性分类（验证集），其中高分辨率计算机断层扫描（HRCT）密度参数进行了测量。基于历史衍生集的九个变量的多元模型（痰液特征）、体格检查（外来音、高共振）、FEV 1/VC和胸部X线摄影（血管纹理增加，支气管瓦特增厚，肺容量增加，肺密度降低）将验证集分为两组，结论：COPD患者的临床表现可反映气流受限的普遍机制。主要表型的标准化鉴定可能允许临床表征COPD，超出其统一的肺量测定定义。(C)2007爱思唯尔有限公司保留所有权利。
Background: Chronic obstructive pulmonary disease (COPD) is characterized by airflow [imitation caused by small airways increased resistance and/or terminal airspaces emphysematous destruction. Spirometric detection of not fully reversible airflow limitation unifies under the acronym COPD, a spectrum of heterogeneous conditions, whose clinical presentations may be substantially different. In a cross-sectional study we aimed to ascertain whether COPD phenotypes reflecting different mechanisms of airflow limitation could be clinically identified.Methods: Multidimensional scaling was used to visualize as a single point in a two-dimension space the multidimensional variables derived from each of 322 COPD patients (derivation set) by clinical, functional, and chest radiographic evaluation. Cluster analysis assigned then a cluster membership to each patient data point. Finally, using cluster membership as dependent variable and all data acquired as independent variables, we developed multivariate models to prospectively classify another group of 93 COPD patients (validation set) in whom high-resolution computerized tomography (HRCT) density parameters were measured.Results: A multivariate model based on nine variables acquired from the derivation set by history (sputum characteristics), physical examination (adventitious sounds, hyperresonance), FEV1/VC, and chest radiography (increased vascular markings, bronchial watt thickening, increased lung volume, reduced lung density) partitioned the validation set into two groups whose clinical, functional, chest radiographic, and HRCT characteristics corresponded to either an airways obstructive or a parenchymal destructive COPD phenotype.Conclusion: Patients with COPD can be assigned a clinical phenotype reflecting the prevalent mechanism of airflow limitation. The standardized identification of the predominant phenotype may permit to clinically characterize COPD beyond its unifying spirometric definition. (C) 2007 Elsevier Ltd. All rights reserved.