Respiratory Institute, Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Institut d'Investigacions Biomediques August Pi i Sunyer, Barcelona, Spain; CIBER Enfermedades Respiratorias, Madrid, Spain.
Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Lancet. 2017 Sep 2;390(10098):980-987. doi: 10.1016/S0140-6736(17)32136-0.
Chronic obstructive pulmonary disease (COPD) is a complex and heterogeneous disease, both at the clinical and biological level. However, COPD is still diagnosed and treated according to simple clinical measures (level of airflow limitation, symptoms, and frequency of previous exacerbations). To address this clinical and biological complexity and to move towards precision medicine in COPD, we need to integrate (bioinformatics) and interpret (clinical science) the vast amount of high-throughput information that existing technology provides (systems biology and network medicine) so diagnosis, stratification, and treatment of patients with COPD can occur on the basis of their pathobiological mechanism (ie, endotypes). Therefore, this Series paper discusses a possible new taxonomy of COPD, the role of endotypes and associated biomarkers and phenotypes, the gaps (and opportunities) in existing knowledge of COPD pathobiology, how systems biology and network medicine can improve understanding of the disease and help to identify relevant endotypes and their specific biomarkers, and how endotypes and their biomarkers can improve the precision, effectiveness, and safety of the treatment of patients with COPD.
慢性阻塞性肺疾病（COPD）在临床和生物学层面上均具有复杂性和异质性。然而，COPD 的诊断和治疗仍然依据简单的临床指标（气流受限程度、症状和既往加重的频率）。为了解决这一临床和生物学的复杂性，并在 COPD 中推进精准医学，我们需要整合（生物信息学）和解释（临床科学）现有技术提供的大量高通量信息（系统生物学和网络医学），以便根据患者的病理生物学机制（即表型）对 COPD 患者进行诊断、分层和治疗。因此，本系列论文讨论了 COPD 可能的新分类法，表型和相关生物标志物及表型的作用，COPD 病理生物学现有知识的差距（和机会），系统生物学和网络医学如何能够提高对疾病的认识，并有助于识别相关表型及其特定的生物标志物，以及表型和生物标志物如何提高 COPD 患者治疗的精确性、有效性和安全性。
