Two novel, severe asthma phenotypes identified during childhood using a clustering approach
Two novel, severe asthma phenotypes identified during childhood using a clustering approach
复制标题
DOI：
10.1183/09031936.00123411
复制
发表时间：
2012-07-01
影响因子：
24.3
通讯作者：
Annesi-Maesano, Isabella
中科院分区：
文献类型：
--
作者：
Just, Jocelyne;Gouvis-Echraghi, Rahele;Annesi-Maesano, Isabella
无监督聚类分析已经被用于识别儿童哮喘的严重表型，但没有考虑炎症标志物。本研究的目的是确定哮喘儿童队列中严重哮喘的独立同质表型簇，对来自法国巴黎Trousseau哮喘项目的315名儿童的19个变量进行聚类分析，确定了3个独立的哮喘簇。第1组，哮喘严重急性发作和多种过敏：103名儿童对吸入性过敏原和食物过敏原更敏感，血嗜酸性粒细胞和嗜碱性粒细胞更多，尽管使用了高剂量的吸入性皮质类固醇，但哮喘更不受控制，因急性发作住院的次数更多。第2组，重度哮喘伴支气管阻塞：72名儿童年龄明显较大，体重指数最高，1秒用力呼气量较低，血液中性粒细胞更明显，除IgE外，所有类别的免疫球蛋白（IG）水平均显著较高。第3组，轻度哮喘：140名儿童没有显示出统计学显著特征。这些结果可以通过优化治疗策略来改善儿童重度哮喘的管理，即抗过敏药物，如过敏表型儿童的抗IgE，以及抗中性粒细胞药物，如阻塞表型儿童的大环内酯类。
Unsupervised cluster analysis has already been used to identify severe phenotypes of childhood asthma, but without taking into account inflammatory markers. The aim of this study was to define independent homogeneous phenotypic clusters of severe asthma in a cohort of asthmatic children.Cluster analysis was applied to 19 variables from 315 children enrolled in the Trousseau Asthma Program in Paris, France.Three independent clusters of asthma were identified. Cluster 1, asthma with severe exacerbations and multiple allergies: 103 children had more sensitisations to inhaled allergens and food allergens, more blood eosinophils and basophils, more uncontrolled asthma despite high doses of inhaled corticosteroid and more hospitalisations for exacerbation. Cluster 2, severe asthma with bronchial obstruction: 72 children were significantly older, had the highest body mass index, a lower forced expiratory volume in 1 s, more pronounced blood neutrophils and significantly higher levels of all classes of immunoglobulin (Ig), except IgE. Cluster 3, mild asthma: 140 children did not show statistically significant features.These results could lead to improved management of severe asthma in children by optimising treatment strategies, i.e. anti-allergic drugs, such as anti-IgE for children with the allergic phenotype, and anti-neutrophil drugs, such as macrolides for those with the obstructive phenotype.