Identification of Subtypes of Refractory Asthma in Korean Patients by Cluster Analysis
Identification of Subtypes of Refractory Asthma in Korean Patients by Cluster Analysis
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DOI：
10.1007/s00408-012-9430-8
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发表时间：
2013-02-01
期刊：
影响因子：
5
通讯作者：
Park, Choon Sik
中科院分区：
文献类型：
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作者：
Jang, An Soo;Kwon, Hyouk-Soo;Park, Choon Sik
难治性哮喘是哮喘的一种亚型，尽管使用了抗哮喘药物，但症状仍不受控制，是一种异质性综合征，具有不同的临床特征，可能有不同的病因和病理生理机制。然而，人们对难治性哮喘的异质性知之甚少。我们的目的是描述难治性哮喘的特征，并提高我们对难治性哮喘患者异质性的理解，我们从韩国哮喘患者队列（n = 2，187）中确定了根据美国胸科协会标准定义的难治性哮喘患者（n = 96）。然后用聚类分析对难治性哮喘进行亚型分类，在研究组中，所有哮喘患者中有4. 4%（n = 96）为难治性哮喘。聚类分析确定了四个不同的难治性哮喘组。第1组和第2组的发病年龄小于第3组和第4组。第1组患者的肺功能保存最好，第2组患者以女性为主，气道阻塞最严重，第3组患者以女性为主，支气管高反应性最强;第4组患者多为男性，且多为吸烟者，提示难治性哮喘是一种异质性综合征，可分为4类亚型不同亚型的潜在发病机制和治疗方法可能不同，需要进一步研究。
Refractory asthma, a subtype of asthma with uncontrolled symptoms despite antiasthma medications, is a heterogeneous syndrome with variable clinical features, presumably different etiologies, and pathophysiological mechanisms. The heterogeneity of refractory asthma, however, is poorly understood. We aimed to characterize refractory asthma and to improve our understanding of the heterogeneity of refractory asthma patients.We identified refractory asthma patients (n = 96) as defined by the American Thoracic Society's criteria from a cohort of Korean asthma patients (n = 2,187). Then, cluster analysis was conducted to classify subtypes of refractory asthma.Among the study group, 4.4 % (n = 96) of all asthma patients had refractory asthma. Cluster analysis identified four distinct groups of refractory asthma. Age at onset was younger in clusters 1 and 2 than in clusters 3 and 4. Patients in cluster 1 had the most well-preserved pulmonary function; patients in cluster 2 had a female predominance and the most severe airway obstruction; patients in cluster 3 were mostly female and had the most enhanced bronchial hyperresponsiveness; and patients in cluster 4 were most male and tended to be cigarette smokers.The current results suggest that refractory asthma is a heterogeneous syndrome and could be classified into four subtypes. Underlying pathogenesis and therapeutic approaches may differ for the different subtypes and further research is needed.