基于聚类的冠心病患者药物治疗模式及人群异质性研究

Drug therapy pattern and population heterogeneity of patients with coronary heart disease based on cluster analysis

目的本研究通过对606名冠心病患者的用药情况进行聚类分析,旨在探讨冠心病患者的药物治疗模式及人群异质性。方法选取2016年10月至2017年10月在首钢医院血管科住院的冠心病患者共606例,回顾性分析患者人口学特征、用药情况、颈动脉超声、脉搏波传导速度测定、血压及相关生化检查等资料。采用K-means方法对用药情况进行聚类,将冠心病人群分成新的类别,并比较不同类别中患者的人口学特征、血管功能以及血压现况。结果606例冠心病患者被划分为5个类别,各类别分别为136、129、110、171和60人,对各类别的人口学特征及血管功能及血压情况进行了比较发现,各类别间在年龄,并发症方面呈现出明显差异,其中类别3,即联合使用β受体阻滞剂、抗血小板类药物(阿司匹林和氯吡格雷)、硝酸酯类药物、他汀类药物治疗的冠心病患者,年龄最小(66.5岁[SD=10.6]),冠心病患病年限最短(61.0岁[SD=11.7]),高血压患病率最小,其余合并症及并发症最少,心血管功能较好,且当前血压恢复情况较好。类别2和类别4的冠心病患者,年龄及患病年限仅次于类别3,其中类别2的患者,高血压患病率最高。类别5的冠心病患者糖尿病患病率最高。类别1为并未采取任何治疗的冠心病患者,有可能是因为患者依从性差,也可能因为收集数据过程中操作不当。结论合并症是选择不同药物治疗模式的重要因素,不同用药模式呈现出的人群异质性在临床中应被广泛关注,本研究为开展个性化治疗和精准医学研究提供帮助。

Objective To conduct a cluster analysis on the medication of 606 patients with CHD to explore the drug therapy mode and population heterogeneity of the patients.Methods This study enrolled 606 patients with CHD who were hospitalized at Vascular Department of Shougang Hospital from October 2016 to October 2017.The data of demographic characteristics,medication,carotid artery ultrasound,pulse wave conduction velocity measurement,blood pressure,and related biochemical examinations were retrospectively analyzed.The patients were divided into new categories by clustering medication status through k-means method.The demographic characteristics,vascular function,and blood pressure status of patients in different categories were compared.Results The 606 patients with CHD were divided into five categories(1-5),which included 136,129,110,171,and 60 patients,respectively.The comparison of demographic characteristics,vascular function,and blood pressure showed that there were significant differences in age and complications among different categories.Patients treated with β blockers,antiplatelet drugs(aspirin and clopidogrel),nitrates,and statins had the lowest age(66.5 years[SD=10.6]),the shortest duration of CHD(61.0 years[SD=11.7]),the lowest prevalence of hypertension,and the least other complications.What's more,their cardiovascular function was good and their current recovery of blood pressure was better.Patients with CHD in categories 2 and 4 were second only to those in category 3 in age and duration of illness.Patients in category 2 had the highest prevalence of hypertension,while patients in category 5 had the highest prevalence of diabetes.Patients in category 1 did not receive any treatment,possibly due to patients'poor compliance or improper data collection.Conclusion Complications are an important factor in the selection of different drug treatment modes.Attention should be paid to the population heterogeneity presented by different drug treatment modes in clinical practice.This study provides ideas for the development of personalized treatment and precision medicine research.