Division of Chest Medicine, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital, No. 138, Sheng-Li Rd, Tainan, 704, Taiwan.
Lung. 2014 Dec;192(6):889-96. doi: 10.1007/s00408-014-9646-x. Epub 2014 Oct 7.
Cluster analysis has been proposed to examine phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). The aim of this study was to use cluster analysis to define COPD phenotypes and validate them by assessing their relationship with mortality.
Male subjects with COPD were recruited to identify and validate COPD phenotypes. Seven variables were assessed for their relevance to COPD, age, FEV(1) % predicted, BMI, history of severe exacerbations, mMRC, SpO(2), and Charlson index. COPD groups were identified by cluster analysis and validated prospectively against mortality during a 4-year follow-up.
Analysis of 332 COPD subjects identified five clusters from cluster A to cluster E. Assessment of the predictive validity of these clusters of COPD showed that cluster E patients had higher all cause mortality (HR 18.3, p < 0.0001), and respiratory cause mortality (HR 21.5, p < 0.0001) than those in the other four groups. Cluster E patients also had higher all cause mortality (HR 14.3, p = 0.0002) and respiratory cause mortality (HR 10.1, p = 0.0013) than patients in cluster D alone.
COPD patient with severe airflow limitation, many symptoms, and a history of frequent severe exacerbations was a novel and distinct clinical phenotype predicting mortality in men with COPD.
聚类分析已被提议用于检查慢性阻塞性肺疾病（COPD）中的表型异质性。本研究的目的是使用聚类分析来定义 COPD 表型，并通过评估它们与死亡率的关系来验证这些表型。
招募了男性 COPD 患者以确定和验证 COPD 表型。评估了与 COPD 相关的七个变量，包括年龄、FEV(1)%预计值、BMI、严重加重史、mMRC、SpO(2)和 Charlson 指数。通过聚类分析确定 COPD 组，并在 4 年随访期间前瞻性验证其对死亡率的影响。
对 332 名 COPD 患者的分析从聚类 A 到聚类 E 确定了五个聚类。评估这些 COPD 聚类的预测有效性表明，E 组患者的全因死亡率（HR 18.3，p<0.0001）和呼吸原因死亡率（HR 21.5，p<0.0001）均高于其他四个组。E 组患者的全因死亡率（HR 14.3，p=0.0002）和呼吸原因死亡率（HR 10.1，p=0.0013）也高于单独的 D 组患者。
严重气流受限、多种症状和频繁严重加重史的 COPD 患者是一种新的、独特的临床表型，可预测男性 COPD 患者的死亡率。
