使用最少资源识别 COPD 表型和可治疗特征：决策树和随时间的稳定性。
COPD profiles and treatable traits using minimal resources: identification, decision tree and stability over time.
机构信息
Lab3R - Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro (ESSUA), Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.
iBiMED - Institute of Biomedicine, Department of Medical Sciences, University of Aveiro, Agras do Crasto - Campus Universitário de Santiago, Edifício 30, 3810-193, Aveiro, Portugal.
出版信息
Respir Res. 2022 Feb 14;23(1):30. doi: 10.1186/s12931-022-01954-6.
BACKGROUND AND OBJECTIVE
Profiles of people with chronic obstructive pulmonary disease (COPD) often do not describe treatable traits, lack validation and/or their stability over time is unknown. We aimed to identify COPD profiles and their treatable traits based on simple and meaningful measures; to develop and validate a decision tree and to explore profile stability over time.
METHODS
An observational, prospective study was conducted. Clinical characteristics, lung function, symptoms, impact of the disease (COPD Assessment Test-CAT), health-related quality of life, physical activity, lower-limb muscle strength and functional status were collected cross-sectionally and a subsample was followed-up monthly over six months. A principal component analysis and a clustering procedure with k-medoids were applied to identify profiles. A decision tree was developed and validated cross-sectionally. Stability was explored over time with the ratio between the number of timepoints that a participant was classified in the same profile and the total number of timepoints (i.e., 6).
RESULTS
352 people with COPD (67.4 ± 9.9 years; 78.1% male; FEV = 56.2 ± 20.6% predicted) participated and 90 (67.6 ± 8.9 years; 85.6% male; FEV = 52.1 ± 19.9% predicted) were followed-up. Four profiles were identified with distinct treatable traits. The decision tree included CAT (< 18 or ≥ 18 points); age (< 65 or ≥ 65 years) and FEV (< 48 or ≥ 48% predicted) and had an agreement of 71.7% (Cohen's Kappa = 0.62, p < 0.001) with the actual profiles. 48.9% of participants remained in the same profile whilst 51.1% moved between two (47.8%) or three (3.3%) profiles over time. Overall stability was 86.8 ± 15%.
CONCLUSION
Four profiles and treatable traits were identified with simple and meaningful measures possibly available in low-resource settings. A decision tree with three commonly used variables in the routine assessment of people with COPD is now available for quick allocation to the identified profiles in clinical practice. Profiles and treatable traits may change over time in people with COPD hence, regular assessments to deliver goal-targeted personalised treatments are needed.
背景与目的
慢性阻塞性肺疾病（COPD）患者的特征通常无法描述可治疗的特征，缺乏验证，并且其稳定性尚不清楚。我们旨在基于简单而有意义的指标确定 COPD 特征及其可治疗的特征；制定和验证决策树，并探索特征随时间的稳定性。
方法
进行了一项观察性、前瞻性研究。收集了临床特征、肺功能、症状、疾病影响（COPD 评估测试- CAT）、健康相关生活质量、身体活动、下肢肌肉力量和功能状态等指标，并在 6 个月内每月进行一次随访。采用主成分分析和 k-均值聚类程序识别特征。横截面开发和验证决策树。通过参与者在同一特征中分类的时间点与总时间点（即 6 个）的比例来探索随时间的稳定性。
结果
352 名 COPD 患者（67.4 ± 9.9 岁；78.1%为男性；FEV = 56.2 ± 20.6%预计值）参与了研究，其中 90 名（67.6 ± 8.9 岁；85.6%为男性；FEV = 52.1 ± 19.9%预计值）进行了随访。确定了四个具有不同可治疗特征的特征。决策树包括 CAT（<18 或≥18 分）；年龄（<65 或≥65 岁）和 FEV（<48 或≥48%预计值），实际特征的一致性为 71.7%（Cohen's Kappa = 0.62，p<0.001）。48.9%的参与者在同一特征中保持不变，而 51.1%的参与者在不同特征（47.8%）或三个特征（3.3%）之间转移。总体稳定性为 86.8 ± 15%。
结论
使用简单而有意义的指标确定了四个特征和可治疗特征，这些指标可能在资源有限的环境中可用。现在可以使用在 COPD 患者常规评估中常用的三个变量制定决策树，以便在临床实践中快速分配给确定的特征。COPD 患者的特征和可治疗特征可能随时间而变化，因此需要定期评估以提供针对目标的个性化治疗。
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