Pinto Lancelot M, Alghamdi Majed, Benedetti Andrea, Zaihra Tasneem, Landry Tara, Bourbeau Jean
Respiratory Division, McGill University Health Centre, Montreal, Quebec, Canada.
Respiratory Epidemiology and Clinical Research Unit, Montreal Chest Institute, McGill University Health Centre, Montreal, Quebec, Canada.
Respir Res. 2015 Apr 18;16(1):50. doi: 10.1186/s12931-015-0208-4.
The traditional classification of COPD, which relies solely on spirometry, fails to account for the complexity and heterogeneity of the disease. Phenotyping is a method that attempts to derive a single or combination of disease attributes that are associated with clinically meaningful outcomes. Deriving phenotypes entails the use of cluster analyses, and helps individualize patient management by identifying groups of individuals with similar characteristics. We aimed to systematically review the literature for studies that had derived such phenotypes using unsupervised methods.
Two independent reviewers systematically searched multiple databases for studies that performed validated statistical analyses, free of definitive pre-determined hypotheses, to derive phenotypes among patients with COPD. Data were extracted independently.
9156 citations were retrieved, of which, 8 studies were included. The number of subjects ranged from 213 to 1543. Most studies appeared to be biased: patients were more likely males, with severe disease, and recruited in tertiary care settings. Statistical methods used to derive phenotypes varied by study. The number of phenotypes identified ranged from 2 to 5. Two phenotypes, with poor longitudinal health outcomes, were common across multiple studies: young patients with severe respiratory disease, few cardiovascular co-morbidities, poor nutritional status and poor health status, and a phenotype of older patients with moderate respiratory disease, obesity, cardiovascular and metabolic co-morbidities.
The recognition that two phenotypes of COPD were often reported may have clinical implications for altering the course of the disease. This review also provided important information on limitations of phenotype studies in COPD and the need for improvement in future studies.
慢性阻塞性肺疾病（COPD）的传统分类仅依赖肺功能测定，未能考虑到该疾病的复杂性和异质性。表型分型是一种试图得出与具有临床意义的结局相关的单一疾病属性或属性组合的方法。得出表型需要使用聚类分析，并通过识别具有相似特征的个体组来帮助实现患者管理的个体化。我们旨在系统回顾文献中使用无监督方法得出此类表型的研究。
两名独立的审阅者系统地在多个数据库中检索研究，这些研究进行了经过验证的统计分析，没有明确的预先设定假设，以在COPD患者中得出表型。数据由独立提取。
共检索到9156条引文，其中纳入了8项研究。受试者数量从213至1543不等。大多数研究似乎存在偏倚：患者更可能为男性，患有严重疾病，且在三级医疗机构招募。用于得出表型的统计方法因研究而异。识别出的表型数量从2至5不等。有两种表型在多项研究中常见，其纵向健康结局较差：一种是患有严重呼吸系统疾病、心血管合并症较少、营养状况差和健康状况不佳的年轻患者，另一种是患有中度呼吸系统疾病、肥胖、心血管和代谢合并症的老年患者。
认识到经常报告的两种COPD表型可能对改变疾病进程具有临床意义。本综述还提供了有关COPD表型研究局限性以及未来研究改进必要性的重要信息。
