聚类分析探讨慢性阻塞性肺疾病急性加重的临床表型

The clinical phenotype of acute exacerbation of chronic obstructive pulmonary disease by cluster analysis

目的利用聚类分析的方法探索慢性阻塞性肺疾病急性加重患者的临床表型,为个体化治疗提供依据。方法纳入2014年1月至2016年12月在我科住院的515例慢性阻塞性肺疾病急性加重患者。收集患者的年龄、病程、吸烟指数、既往1年住院次数、住院天数、治疗花费等数据进行聚类分析。结果患者可分为3种表型:“轻型-糖皮质激素抵抗-抗生素依赖型”、“轻型-糖皮质激素敏感型”、“严重-并发症型”。前两种表型的患者病情较轻,住院花费较少,二者在不同途径的糖皮质激素使用时间和累计剂量、抗生素使用率和使用时间上存在差异。第三种表型病情最为严重,住院花费最高,可能合并或并发心血管、消化道等疾病。结论利用聚类分析能识别出慢性阻塞性肺疾病急性加重的不同表型,有可能为临床的个体化治疗提供参考。

Objective To explore the clinical phenotype of patients with acute exacerbation of chronic obstructive pulmonary disease(COPD) by cluster analysis and provide a basis for individualized treatment. Methods A total of 515 patients with acute exacerbation of COPD admitted to this department from January 2014 to December 2016 were enrolled. The age, duration, smoking index, number of hospitalizations in the past 1 year, hospitalization days, treatment costs and other information were collected for cluster analysis. Results The patients were divided into three categories of phenotype: "mild-glucocorticoid resistance-antibiotic dependent","mild-glucocorticoid sensitive", and "serious complication". The patients with the first two phenotypes had a milder condition and lower hospitalization costs.There were differences in the time and cumulative dose of glucocorticoids in different pathways, antibiotic use time and usage rate. The third phenotype was the most serious, with the highest cost of hospitalization, and may merge or co-exist with other diseases such as cardiovascular disease and digestive tract disease. Conclusion Cluster analysis may identify different phenotypes of acute exacerbation of COPD to provide a reference for clinical individualized treatment.