Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu, 431-3192, Japan.
Department of Respiratory Medicine, Shizuoka City Shimizu Hospital, 1231 Miyakami, Shizuoka, 424-8636, Japan.
BMC Pulm Med. 2021 Feb 22;21(1):63. doi: 10.1186/s12890-021-01428-3.
The precise classification of idiopathic interstitial pneumonia (IIP) is essential for selecting treatment as well as estimating clinical outcomes; however, this is sometimes difficult in clinical practice. Therefore, cluster analysis was used to identify the clinical phenotypes of IIPs, and its usefulness for predicting clinical outcomes was evaluated.
Cluster analysis was performed using clinical features including patients' demographics; histories; pulmonary function test data; and laboratory, physical and radiological findings.
In 337 patients with IIPs, four clusters were identified: Cluster I, in which > 80% of the patients had autoimmune features; Cluster II, which had the lowest rate of smoking, the lowest percent predicted forced vital capacity (%FVC) and the lowest body mass index (BMI); Cluster III, which had the highest rate of smoking, the highest rate of dust exposure, the second lowest %FVC and normal BMI; and Cluster IV, which exhibited maintenance of %FVC and normal BMI. Cluster IV had significantly longer overall survival than Clusters II and III. Clusters I and III had significantly longer overall survival than Cluster II. Clusters II and III had a significantly higher cumulative incidence of acute exacerbation than Cluster IV.
Cluster analysis using clinical features identified four clinical phenotypes of IIPs, which may be useful for predicting the risk of acute exacerbation and overall survival.
特发性间质性肺炎（IIP）的准确分类对于选择治疗方法和评估临床结局至关重要；然而，在临床实践中有时很难做到这一点。因此，我们采用聚类分析来确定 IIP 的临床表型，并评估其对预测临床结局的有用性。
采用聚类分析方法，对包括患者人口统计学特征、病史、肺功能检查数据、实验室、物理和影像学发现等临床特征进行分析。
在 337 例 IIP 患者中，确定了 4 个聚类：聚类 I，其中>80%的患者具有自身免疫特征；聚类 II，吸烟率最低，预计用力肺活量（%FVC）最低，体重指数（BMI）最低；聚类 III，吸烟率最高，粉尘暴露率最高，%FVC 第二低，BMI 正常；聚类 IV，%FVC 维持正常，BMI 正常。与聚类 II 和 III 相比，聚类 IV 的总生存期明显延长。聚类 I 和 III 的总生存期明显长于聚类 II。聚类 II 和 III 的急性加重累积发生率明显高于聚类 IV。
使用临床特征的聚类分析确定了 IIP 的 4 种临床表型，这可能有助于预测急性加重和总生存期的风险。
