Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program.
Heterogeneity of severe asthma in childhood: confirmation by cluster analysis of children in the National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program.
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DOI：
10.1016/j.jaci.2010.11.015
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发表时间：
2011-02
期刊：
影响因子：
--
通讯作者：
National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program
中科院分区：
文献类型：
--
作者：
Fitzpatrick AM;Teague WG;Meyers DA;Peters SP;Li X;Li H;Wenzel SE;Aujla S;Castro M;Bacharier LB;Gaston BM;Bleecker ER;Moore WC;National Institutes of Health/National Heart, Lung, and Blood Institute Severe Asthma Research Program
儿童哮喘是一种具有多种表型的异质性疾病。虽然无监督聚类分析是一个有用的工具，用于识别表型，它还没有被应用到学龄儿童持续哮喘在广泛的严重程度。这项研究确定了严重哮喘儿童在聚类分析中的分布情况，以及这些聚类与当前哮喘严重程度定义的一致性。聚类分析应用于12个连续和复合变量从161名儿童在5个中心参加了严重哮喘研究计划（SARP）。确定了四组哮喘。第1组（n = 48）的儿童肺功能相对正常，特应性较低，而第2组（n = 52）的儿童肺功能略低，特应性较高，症状和药物使用增加。第3组（n = 32）有更高的合并症，支气管反应性增加和肺功能降低。第4组（n = 29）的肺功能最低，症状和药物使用最多。聚类分配的预测因子是哮喘持续时间、控制哮喘药物的数量和基线肺功能。重度哮喘儿童出现在所有的聚类中，没有一个聚类与哮喘治疗指南中提供的哮喘严重程度定义相对应。儿童重度哮喘具有高度异质性。以前在成人中鉴定的独特表型簇也可以在儿童中鉴定，但具有重要的差异。需要更大规模的验证和纵向研究来确定这些表型簇在更大临床环境中的基线和预测有效性。
Asthma in children is a heterogeneous disorder with many phenotypes. Although unsupervised cluster analysis is a useful tool for identifying phenotypes, it has not been applied to school-age children with persistent asthma across a wide range of severities. This study determined how children with severe asthma are distributed across a cluster analysis and how well these clusters conform to current definitions of asthma severity. Cluster analysis was applied to 12 continuous and composite variables from 161 children at 5 centers enrolled in the Severe Asthma Research Program (SARP). Four clusters of asthma were identified. Children in Cluster 1 (n = 48) had relatively normal lung function and less atopy, while children in Cluster 2 (n = 52) had slightly lower lung function, more atopy, and increased symptoms and medication usage. Cluster 3 (n = 32) had greater co-morbidity, increased bronchial responsiveness and lower lung function. Cluster 4 (n = 29) had the lowest lung function and the greatest symptoms and medication usage. Predictors of cluster assignment were asthma duration, the number of asthma controller medications, and baseline lung function. Children with severe asthma were present in all clusters, and no cluster corresponded to definitions of asthma severity provided in asthma treatment guidelines. Severe asthma in children is highly heterogeneous. Unique phenotypic clusters previously identified in adults can also be identified in children, but with important differences. Larger validation and longitudinal studies are needed to determine the baseline and predictive validity of these phenotypic clusters in the larger clinical setting.
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影响因子：
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