聚类分析数据表明成人哮喘临床表型与其二十年后的预后相关
2020/01/02
摘要
背景：哮喘是一种异质性疾病，通过聚类分析研究方法可识别哮喘的特定表型。但目前不同哮喘临床表型患者的具体长期临床进程尚未被明确，而其又是支撑聚类分析法关联临床表型与临床表现的关键因素。因此，本文旨在比较20年前定义的不同哮喘集群患者间不良哮喘事件的发生风险。
方法：此研究中所有成人哮喘患者数据均来自欧洲共同体呼吸系统健康调查（ECRHS）和哮喘遗传学和环境学的流行病学研究（EGEA）系统，所有患者随访周期为20年。通过建立回归模型比较20年前聚类分析法定义的7种不同哮喘表型患者在随访过程中的临床特征（现发哮喘，哮喘急性发作，哮喘控制，生活质量和FEV1）及FEV1进程。
结果：此研究共纳入1325名成人哮喘患者。研究表明，随访过程中7种哮喘表型患者间各种哮喘典型不良结局的发生率均存在显著差异。与临床症状最轻的哮喘表型患者相比，其他表型的患者发生哮喘急性发作的风险为0.9倍（0.4-2.0）到4.0倍（2.0-7.8）不等，回归分析显示FEV1％预计值的OR值为0.6（3.5-4.6）至-9.9（-14.2- -5.5）不等。而FEV1随时间变化情况在各表型之间未见显著差异。
结论：我们研究结果显示20年前定义的不同成人哮喘表型患者间不良哮喘结局发生的长期风险存在差异，表明哮喘临床表型的划分可强烈提示临床进程中患者的哮喘发作情况及肺功能受损情况。
associated with asthma outcomes twenty years later.
Boudier A, et al. Allergy. 2018 Dec 13.
Abstract
Background: Research based on cluster analyses led to the identification of particular phenotypes confirming phenotypic heterogeneity of asthma. The long-term clinical course of asthma phenotypes defined by clustering analysis remains unknown, although it is a key aspect to underpin their clinical relevance. We aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier.
METHODS: The study relied on two cohorts of adults with asthma with 20-year follow-up, ECRHS (European Community Respiratory Health Survey) and EGEA (Epidemiological study on Genetics and Environment of Asthma). Regression models were used to compare asthma characteristics (current asthma, asthma exacerbations, asthma control, quality of life and FEV1) at follow-up and the course of FEV1 between seven cluster-based asthma phenotypes identified 20 years earlier.
RESULTS: The analysis included 1325 adults with ever asthma. For each asthma characteristic assessed at follow-up, the risk for adverse outcomes differed significantly between the seven asthma clusters identified at baseline. As compared with the mildest asthma phenotype, ORs (95%CI) for asthma exacerbations varied from 0.9 (0.4 to 2.0) to 4.0 (2.0 to 7.8) and the regression estimates (95%CI) for FEV1% predicted varied from 0.6 (-3.5 to 4.6) to -9.9 (-14.2 to -5.5) between clusters. Change of FEV1 over time did not differ significantly across clusters.
CONCLUSION: Our findings show that the long-term risk for poor asthma outcomes differed between comprehensive adult asthma phenotypes identified 20-years earlier and suggest a strong tracking of asthma activity and impaired lung function over time.
背景：哮喘是一种异质性疾病，通过聚类分析研究方法可识别哮喘的特定表型。但目前不同哮喘临床表型患者的具体长期临床进程尚未被明确，而其又是支撑聚类分析法关联临床表型与临床表现的关键因素。因此，本文旨在比较20年前定义的不同哮喘集群患者间不良哮喘事件的发生风险。
方法：此研究中所有成人哮喘患者数据均来自欧洲共同体呼吸系统健康调查（ECRHS）和哮喘遗传学和环境学的流行病学研究（EGEA）系统，所有患者随访周期为20年。通过建立回归模型比较20年前聚类分析法定义的7种不同哮喘表型患者在随访过程中的临床特征（现发哮喘，哮喘急性发作，哮喘控制，生活质量和FEV1）及FEV1进程。
结果：此研究共纳入1325名成人哮喘患者。研究表明，随访过程中7种哮喘表型患者间各种哮喘典型不良结局的发生率均存在显著差异。与临床症状最轻的哮喘表型患者相比，其他表型的患者发生哮喘急性发作的风险为0.9倍（0.4-2.0）到4.0倍（2.0-7.8）不等，回归分析显示FEV1％预计值的OR值为0.6（3.5-4.6）至-9.9（-14.2- -5.5）不等。而FEV1随时间变化情况在各表型之间未见显著差异。
结论：我们研究结果显示20年前定义的不同成人哮喘表型患者间不良哮喘结局发生的长期风险存在差异，表明哮喘临床表型的划分可强烈提示临床进程中患者的哮喘发作情况及肺功能受损情况。
(中国医科大学附属一院呼吸与危重症学科 李文扬 摘译 杨冬 审校)
(Boudier A, et al. Allergy. 2018 Dec 13.)
Data-driven adult asthma phenotypes based on clinical characteristics are (Boudier A, et al. Allergy. 2018 Dec 13.)
associated with asthma outcomes twenty years later.
Boudier A, et al. Allergy. 2018 Dec 13.
Abstract
Background: Research based on cluster analyses led to the identification of particular phenotypes confirming phenotypic heterogeneity of asthma. The long-term clinical course of asthma phenotypes defined by clustering analysis remains unknown, although it is a key aspect to underpin their clinical relevance. We aimed to estimate risk of poor asthma events between asthma clusters identified 20 years earlier.
METHODS: The study relied on two cohorts of adults with asthma with 20-year follow-up, ECRHS (European Community Respiratory Health Survey) and EGEA (Epidemiological study on Genetics and Environment of Asthma). Regression models were used to compare asthma characteristics (current asthma, asthma exacerbations, asthma control, quality of life and FEV1) at follow-up and the course of FEV1 between seven cluster-based asthma phenotypes identified 20 years earlier.
RESULTS: The analysis included 1325 adults with ever asthma. For each asthma characteristic assessed at follow-up, the risk for adverse outcomes differed significantly between the seven asthma clusters identified at baseline. As compared with the mildest asthma phenotype, ORs (95%CI) for asthma exacerbations varied from 0.9 (0.4 to 2.0) to 4.0 (2.0 to 7.8) and the regression estimates (95%CI) for FEV1% predicted varied from 0.6 (-3.5 to 4.6) to -9.9 (-14.2 to -5.5) between clusters. Change of FEV1 over time did not differ significantly across clusters.
CONCLUSION: Our findings show that the long-term risk for poor asthma outcomes differed between comprehensive adult asthma phenotypes identified 20-years earlier and suggest a strong tracking of asthma activity and impaired lung function over time.
