Identification and validation of asthma phenotypes in Chinese population using cluster analysis
Identification and validation of asthma phenotypes in Chinese population using cluster analysis
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使用聚类分析识别和验证中国人群哮喘表型
DOI：
10.1016/j.anai.2017.07.016
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发表时间：
2017-10-01
影响因子：
5.9
通讯作者：
Wang, Gang
中科院分区：
文献类型：
--
作者：
Wang, Lei;Liang, Rui;Wang, Gang
背景：哮喘是一种异质性气道疾病，因此明确识别临床表型以实现更好的哮喘管理至关重要。目的：识别并前瞻性验证中国人群中的哮喘群。方法：连续招募 284 名患者，收集 18 个社会人口学和临床变量。通过 Ward 方法进行层次聚类分析，然后进行 k 均值聚类分析。然后，使用前瞻性 12 个月队列研究来验证所识别的簇。结果：成功识别了 5 个簇。集群 1 (n = 71) 和集群 3 (n = 81) 是轻度哮喘表型，具有轻微气道阻塞和低恶化风险，但存在性别差异。第 2 组 (n = 65) 描述了“过敏”表型，第 4 组 (n = 33) 描述了吸烟导致的“固定气流受限”表型，第 5 组 (n = 34) 描述了“低社会经济地位”表型。集群 2、4 和 5 中的患者社会经济地位明显较低，心理症状较多。集群 2 的病情加重风险显着增加（风险比 [RR] 1.13，95% 置信区间 [CI] 1.03-1.25）、计划外哮喘就诊（RR 1.98，95% CI 1.07-3.66）和哮喘紧急就诊（RR 7.17，95% CI 1.26-40.80）。聚类 4 的计划外就诊风险增加（RR 2.22，95% CI 1.02-4.81），聚类 5 的紧急就诊风险增加（RR 12.72，95% CI 1.95-69.78）。 Kaplan-Meier 分析证实，集群分组可以预测首次哮喘发作、计划外就诊、急诊就诊和入院的时间（所有比较 P < .0001）。结论：我们确定了 3 个临床集群，即“过敏性哮喘”、“固定气流受限”和“低社会经济地位”表型，这些表型存在严重哮喘发作的高风险 这对发展中国家的临床实践具有管理意义。 (C) 2017 年美国过敏、哮喘和免疫学学院。由爱思唯尔公司出版。保留所有权利。
Background: Asthma is a heterogeneous airway disease, so it is crucial to clearly identify clinical phenotypes to achieve better asthma management.Objective: To identify and prospectively validate asthma clusters in a Chinese population.Methods: Two hundred eighty-four patients were consecutively recruited and 18 sociodemographic and clinical variables were collected. Hierarchical cluster analysis was performed by the Ward method followed by k-means cluster analysis. Then, a prospective 12-month cohort study was used to validate the identified clusters.Results: Five clusters were successfully identified. Clusters 1 (n = 71) and 3 (n = 81) were mild asthma phenotypes with slight airway obstruction and low exacerbation risk, but with a sex differential. Cluster 2 (n = 65) described an "allergic" phenotype, cluster 4 (n = 33) featured a "fixed airflow limitation" phenotype with smoking, and cluster 5 (n = 34) was a "low socioeconomic status" phenotype. Patients in clusters 2, 4, and 5 had distinctly lower socioeconomic status and more psychological symptoms. Cluster 2 had a significantly increased risk of exacerbations (risk ratio [RR] 1.13, 95% confidence interval [CI] 1.03-1.25), unplanned visits for asthma (RR 1.98, 95% CI 1.07-3.66), and emergency visits for asthma (RR 7.17, 95% CI 1.26-40.80). Cluster 4 had an increased risk of unplanned visits (RR 2.22, 95% CI 1.02-4.81), and cluster 5 had increased emergency visits (RR 12.72, 95% CI 1.95-69.78). Kaplan-Meier analysis confirmed that cluster grouping was predictive of time to the first asthma exacerbation, unplanned visit, emergency visit, and hospital admission (P < .0001 for all comparisons).Conclusion: We identified 3 clinical clusters as "allergic asthma," "fixed airflow limitation," and "low socioeconomic status" phenotypes that are at high risk of severe asthma exacerbations and that have management implications for clinical practice in developing countries. (C) 2017 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.