基于肺外可治疗性状的哮喘表型鉴定
2020/08/20
摘要
背景：哮喘是一种异质性和复杂性疾病，既往未见基于肺外可治疗性状的哮喘表型的描述。
目的：根据临床、肺功能、人体三维数据和心理特征，对中重度哮喘受试者进行聚类分析。
方法：这是一项涉及巴西和澳大利亚多中心的横断面研究。连续招募中重度哮喘受试者（N = 296）。评估其活动和久坐时间、哮喘控制，人体三维数据，肺功能，心理健康状况。通过分层聚类分析对参与者进行分类，并使用方差分析，Kruskal-Wallis和卡方检验对聚类结果进行比较。使用多元和线性回归模型评估变量之间的相关性。
结果：最终确定了四个集群：（1）体育锻炼多的控制性哮喘；（2）锻炼不足且久坐的未控制哮喘；（3）锻炼少的未控制哮喘，同时伴有肥胖症、焦虑和/或抑郁症状（4）哮喘控制最差的患者，锻炼少，久坐不动，肥胖、焦虑和/或抑郁状态。长时间久坐，女性和焦虑与病情加重相关，而体育锻炼则是住院的保护因素。哮喘控制与性别、急性加重、体育锻炼和身体健康状况有关。
结论：缺乏运动，肥胖、焦虑和/或抑郁症状等特征与较差的哮喘预后相关，并且与哮喘控制密切相关。该聚类分析显示了评估肺外性状以改善中重度哮喘患者的个性化管理和预后的重要性。
Identification of asthma phenotypes based on extrapulmonary treatable traits
Patricia Duarte Freitas , Rafaella França Xavier , Vanessa Marie McDonald , Peter Gerard Gibson , Laura Cordova-Rivera , Karina Couto Furlanetto , Joice Mara de Oliveira , Regina Maria Carvalho-Pinto , Alberto Cukier , Rafael Stelmach , Celso Ricardo Fernandes Carvalho
Abstract
Background: Asthma is a heterogeneous and complex disease, and the description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.
Objective: to identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in participants with moderate-to-severe asthma.
Methods: This is a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (N=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function, psychological, and health-status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal-Wallis, and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.
Results: We identified four clusters: (1)controlled asthma who were physically active, (2)uncontrolled asthma who were physically inactive and more sedentary, (3)uncontrolled asthma with low physical activity, who were also obese and experienced anxiety and/or depression symptoms (4)very uncontrolled asthma, who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex, and anxiety symptoms were associated with increased odds of exacerbation risk while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity, and health-status.
Conclusion: Traits such as physical inactivity, obesity, and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably with asthma control. This cluster analysis supports the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.
背景：哮喘是一种异质性和复杂性疾病，既往未见基于肺外可治疗性状的哮喘表型的描述。
目的：根据临床、肺功能、人体三维数据和心理特征，对中重度哮喘受试者进行聚类分析。
方法：这是一项涉及巴西和澳大利亚多中心的横断面研究。连续招募中重度哮喘受试者（N = 296）。评估其活动和久坐时间、哮喘控制，人体三维数据，肺功能，心理健康状况。通过分层聚类分析对参与者进行分类，并使用方差分析，Kruskal-Wallis和卡方检验对聚类结果进行比较。使用多元和线性回归模型评估变量之间的相关性。
结果：最终确定了四个集群：（1）体育锻炼多的控制性哮喘；（2）锻炼不足且久坐的未控制哮喘；（3）锻炼少的未控制哮喘，同时伴有肥胖症、焦虑和/或抑郁症状（4）哮喘控制最差的患者，锻炼少，久坐不动，肥胖、焦虑和/或抑郁状态。长时间久坐，女性和焦虑与病情加重相关，而体育锻炼则是住院的保护因素。哮喘控制与性别、急性加重、体育锻炼和身体健康状况有关。
结论：缺乏运动，肥胖、焦虑和/或抑郁症状等特征与较差的哮喘预后相关，并且与哮喘控制密切相关。该聚类分析显示了评估肺外性状以改善中重度哮喘患者的个性化管理和预后的重要性。
(中日友好医院呼吸与危重症医学科 李红雯 摘译 林江涛 审校)
(Eur Respir J. 2020 Jul 30;2000240. doi: 10.1183/13993003.00240-2020.)
(Eur Respir J. 2020 Jul 30;2000240. doi: 10.1183/13993003.00240-2020.)
Identification of asthma phenotypes based on extrapulmonary treatable traits
Patricia Duarte Freitas , Rafaella França Xavier , Vanessa Marie McDonald , Peter Gerard Gibson , Laura Cordova-Rivera , Karina Couto Furlanetto , Joice Mara de Oliveira , Regina Maria Carvalho-Pinto , Alberto Cukier , Rafael Stelmach , Celso Ricardo Fernandes Carvalho
Abstract
Background: Asthma is a heterogeneous and complex disease, and the description of asthma phenotypes based on extrapulmonary treatable traits has not been previously reported.
Objective: to identify and characterise clusters based on clinical, functional, anthropometrical, and psychological characteristics in participants with moderate-to-severe asthma.
Methods: This is a cross-sectional multicentre study involving centres from Brazil and Australia. Participants (N=296) with moderate-to-severe asthma were consecutively recruited. Physical activity and sedentary time, clinical asthma control, anthropometric data, pulmonary function, psychological, and health-status were evaluated. Participants were classified by hierarchical cluster analysis and the clusters compared using ANOVA, Kruskal-Wallis, and Chi-square tests. Multiple logistic and linear regression models were performed to evaluate the association between variables.
Results: We identified four clusters: (1)controlled asthma who were physically active, (2)uncontrolled asthma who were physically inactive and more sedentary, (3)uncontrolled asthma with low physical activity, who were also obese and experienced anxiety and/or depression symptoms (4)very uncontrolled asthma, who were physically inactive, more sedentary, obese and experienced anxiety and/or depression symptoms. Higher levels of sedentary time, female sex, and anxiety symptoms were associated with increased odds of exacerbation risk while being more active showed a protective factor for hospitalisation. Asthma control was associated with sex, the occurrence of exacerbation, physical activity, and health-status.
Conclusion: Traits such as physical inactivity, obesity, and symptoms of anxiety and/or depression were associated with worse asthma outcomes, and closely and inextricably with asthma control. This cluster analysis supports the importance of assessing extrapulmonary traits to improve personalised management and outcomes for people with moderate and severe asthma.
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儿童期哮喘的独特免疫表型
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需住院治疗的COVID-19肺炎哮喘患者的特征和结局
