Gagnon Philippe, Casaburi Richard, Saey Didier, Porszasz Janos, Provencher Steeve, Milot Julie, Bourbeau Jean, O'Donnell Denis E, Maltais François
Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, Québec, Canada.
Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, California, United States of America.
PLoS One. 2015 Apr 23;10(4):e0123626. doi: 10.1371/journal.pone.0123626. eCollection 2015.
We hypothesized that heterogeneity exists within the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 spirometric category and that different subgroups could be identified within this GOLD category.
Pre-randomization study participants from two clinical trials were symptomatic/asymptomatic GOLD 1 chronic obstructive pulmonary disease (COPD) patients and healthy controls. A hierarchical cluster analysis used pre-randomization demographics, symptom scores, lung function, peak exercise response and daily physical activity levels to derive population subgroups.
Considerable heterogeneity existed for clinical variables among patients with GOLD 1 COPD. All parameters, except forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC), had considerable overlap between GOLD 1 COPD and controls. Three-clusters were identified: cluster I (18 [15%] COPD patients; 105 [85%] controls); cluster II (45 [80%] COPD patients; 11 [20%] controls); and cluster III (22 [92%] COPD patients; 2 [8%] controls). Apart from reduced diffusion capacity and lower baseline dyspnea index versus controls, cluster I COPD patients had otherwise preserved lung volumes, exercise capacity and physical activity levels. Cluster II COPD patients had a higher smoking history and greater hyperinflation versus cluster I COPD patients. Cluster III COPD patients had reduced physical activity versus controls and clusters I and II COPD patients, and lower FEV1/FVC versus clusters I and II COPD patients.
The results emphasize heterogeneity within GOLD 1 COPD, supporting an individualized therapeutic approach to patients.
www.clinicaltrials.gov. NCT01360788 and NCT01072396.
我们假设慢性阻塞性肺疾病全球倡议组织（GOLD）1级肺量计分类中存在异质性，并且可以在该GOLD分类中识别出不同的亚组。
来自两项临床试验的随机分组前研究参与者为有症状/无症状的GOLD 1级慢性阻塞性肺疾病（COPD）患者和健康对照者。采用分层聚类分析，根据随机分组前的人口统计学、症状评分、肺功能、运动峰值反应和日常身体活动水平来划分人群亚组。
GOLD 1级COPD患者的临床变量存在相当大的异质性。除1秒用力呼气容积（FEV1）/用力肺活量（FVC）外，所有参数在GOLD 1级COPD患者和对照者之间都有相当大的重叠。识别出三个聚类：聚类I（18名[15%]COPD患者；105名[85%]对照者）；聚类II（45名[80%]COPD患者；11名[20%]对照者）；聚类III（22名[92%]COPD患者；2名[8%]对照者）。与对照者相比，聚类I的COPD患者除了弥散能力降低和基线呼吸困难指数较低外，肺容积、运动能力和身体活动水平均保持正常。与聚类I的COPD患者相比，聚类II的COPD患者吸烟史更长，肺过度充气更严重。与对照者以及聚类I和II的COPD患者相比，聚类III的COPD患者身体活动减少，与聚类I和II的COPD患者相比，FEV1/FVC更低。
结果强调了GOLD 1级COPD中的异质性，支持对患者采取个体化治疗方法。
