Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis
Certain subphenotypes of aspirin-exacerbated respiratory disease distinguished by latent class analysis
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DOI：
10.1016/j.jaci.2013.07.004
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发表时间：
2014-01-01
影响因子：
14.2
通讯作者：
Nizankowska-Mogilnicka, Ewa
中科院分区：
文献类型：
--
作者：
Bochenek, Grazyna;Kuschill-Dziurda, Joanna;Nizankowska-Mogilnicka, Ewa
背景：阿斯匹林加重呼吸系统疾病（AERD）被认为是一种独特的哮喘表型。它通常伴有慢性增生性嗜酸性鼻窦炎伴鼻息肉、血嗜酸性粒细胞增多和尿白三烯E-4 （LTE4）浓度增高。对个别患者进行更深入的分析表明，这一群体是不均匀的。目的：我们试图通过应用潜在分类分析（LCA）在一组AERD患者中识别任何可能的亚表型。方法：对201例AERD患者（女性134例）的临床资料进行问卷调查。评估标准肺活量测定、特应性特征、血嗜酸性粒细胞和尿LTE4浓度。应用LCA鉴定可能的AERD亚表型。结果：在AERD表型中确定了四类（亚表型）：1类，中度哮喘，上呼吸道症状加重，血嗜酸性粒细胞增多（18.9%的患者）；2类，哮喘病程较轻，控制相对较好，卫生保健使用率低（34.8%）；3类，哮喘病程严重，控制不良，有严重恶化和气道阻塞（41.3%的患者）；第4类，控制不良的哮喘，女性受试者频繁和严重发作（5.0%）。特应性状态不影响班级成员。上呼吸道症状特别严重的患者血嗜酸性粒细胞水平最高，尿LTE4浓度最高。结论：LCA揭示了独特的AERD亚表型，从而证实了该人群的异质性。这种区别对待可能有助于对难以治疗的患者进行更个性化的治疗。
Background: Aspirin-exacerbated respiratory disease (AERD) is recognized as a distinct asthma phenotype. It usually has a severe course accompanied by chronic hyperplastic eosinophilic sinusitis with nasal polyps, blood eosinophilia, and increased concentrations of urinary leukotriene E-4 (LTE4). More insightful analysis of individual patients shows this group to be nonhomogeneous.Objective: We sought to identify any likely subphenotypes in a cohort of patients with AERD through the application of latent class analysis (LCA).Methods: Clinical data from 201 patients with AERD (134 women) were collected from questionnaires. Standard spirometry, atopy traits, blood eosinophilia, and urinary LTE4 concentrations were evaluated. LCA was applied to identify possible AERD subphenotypes.Results: Four classes (subphenotypes) within the AERD phenotype were identified as follows: class 1, asthma with a moderate course, intensive upper airway symptoms, and blood eosinophilia (18.9% of patients); class 2, asthma with a mild course, relatively well controlled, and with low health care use (34.8% of patients); class 3, asthma with a severe course, poorly controlled, and with severe exacerbations and airway obstruction (41.3% of patients); and class 4, poorly controlled asthma with frequent and severe exacerbations in female subjects (5.0% of patients). Atopic status did not affect class membership. Patients with particularly intensive upper airway symptoms had the highest levels of blood eosinophilia and the highest concentrations of urinary LTE4.Conclusions: LCA revealed unique AERD subphenotypes, thus corroborating the heterogeneity of this population. Such discrimination might facilitate more individualized treatment in difficult-to-treat patients.