哮喘联盟

   摘要
   目的：尽管大部分哮喘患者随时间的推移其肺功能仍然维持在正常状态，但仍有部分患者会出现肺功能加速下降。保存肺功能是哮喘管理的一个重要方面。而遵循哮喘指南对于能否预防肺功能下降仍然存有争论。本研究旨在确定伴有明显肺功能下降的哮喘患者的分布特征，并使用层序聚类分析法明确遵循临床指南治疗的这类患者的特征性临床表现。
   方法：对纳入的86例无吸烟史哮喘患者，采用逐步多元回归法分析所筛选出的与临床表型相关的8个变量。层序聚类分析则采用Ward's法建立聚类图，用以评估人群中的聚类例数以及他们之间的差异。
   结果：共发现3个不同的聚类。聚类1(n = 40) 为女性迟发型哮喘患者。聚类2(n = 17)为早发型哮喘患者、特应性和长病程哮喘患者。聚类3 (n = 29) 大部分为迟发型哮喘、急性发作频率较低、基线FEV1占预计值较低的老年男性患者。聚类1的患者FEV1的年平均下降速率为69 mL/年，是3个聚类中肺功能下降最为迅速的患者。
   结论：研究发现尽管基于使用主观症状构建的指南进行了恰当的哮喘治疗，但仍有一部分亚组患者的肺功能出现加速下降。
 

（林江涛 审校）
J Asthma. 2013 Oct 8. [Epub ahead of print]


 

Cluster analysis identifies characteristic phenotypes of asthma with accelerated lung function decline.
 

Sakagami T, Hasegawa T, Koya T, Furukawa T, Kawakami H, Kimura Y, Hoshino Y, Sakamoto H, Shima K, Kagamu H, Suzuki EI, Narita I.
 

ABSTRACT
OBJECTIVE: While the majority of individuals with asthma retain normal lung function over time, some exhibit accelerated lung function decline. Preservation of lung function is an important aspect of asthma management. Whether the asthma guidelines can prevent lung function decline remains controversial. This study was performed to determine the distribution of asthmatic subjects with greater lung function decline and to identify characteristic clinical features of such subjects treated in accordance with clinical guidelines by using hierarchical cluster analysis.
METHODS: Eighty-six asthmatic subjects without a history of smoking were assessed with respect to 8 variables selected from clinical phenotypes by using step-wise multiple regression analysis. Hierarchical cluster analysis using Ward's method generated a dendrogram for estimation of the number of clusters within the population and the differences between them.
RESULTS: Three distinct clusters were identified. Cluster 1 (n = 40) comprised women with late-onset asthma. Cluster 2 (n = 17) comprised subjects with early-onset asthma, atopy, and long disease duration. Cluster 3 (n = 29) predominantly comprised older men who had late-onset asthma, a lower prevalence of exacerbation, and a lower predicted % forced expiratory volume in 1 s (FEV1) at baseline. Subjects in cluster 1 showed a mean decline in FEV1 of 69 mL/year, which was the greatest lung function decline among the 3 clusters.
CONCLUSION: We identified a subgroup of patients with accelerated lung function decline despite appropriate asthma treatment based on guidelines constructed by using subjective symptoms.
 

J Asthma. 2013 Oct 8. [Epub ahead of print]