Yang Mengjiao, Wang Ziwei, Zhao Yangyang, He Jie, Lin Dier, Wang Yali, Liu Yang
Department of Cardiovascular Surgery, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People's Republic of China.
Department of Respiratory and Critical Care Medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jun 12;20:1927-1937. doi: 10.2147/COPD.S517270. eCollection 2025.
Chronic obstructive pulmonary disease (COPD) exhibits heterogeneous symptom profiles across individuals. This study aimed to identify subgroups of patients with stable COPD according to physiological, psychological, and environmental symptoms; assess differences in their characteristics; and examine the association of symptom patterns with frailty.
We analyzed data from the second wave of a cohort study involving patients with COPD reassessed 6 months after hospitalization for acute exacerbations. Frailty and patient-reported outcomes were measured using the FRAIL and Modified COPD-Patient-Reported Outcome (mCOPD-PRO) scales. Latent profile analysis identified subgroups based on mCOPD-PRO symptom patterns. Differences across symptom severity subgroups were assessed using post-hoc trend analyses and chi-square tests for trends. Multinomial logistic regression quantified the magnitude of differences between subgroups. The relationship between subgroups, clinical factors, and frailty was examined through linear regression.
Among 308 patients with stable COPD, three subgroups were identified: "low-symptom" (27.9%), "moderate-symptom" (51.3%), and "severe-symptom" (20.8%). Body mass index, Global Initiative for Chronic Obstructive Lung Disease stage (GOLD), COPD Assessment Test (CAT) score, modified Medical Research Council (mMRC) score, and physical activity exhibited significant linear trends across subgroups of increasing symptom severity. Frailty scores differed significantly: 0.50 ± 0.78 in the low-symptom group, 1.34 ± 0.96 in the moderate-symptom group, and 2.72 ± 0.95 in the severe-symptom group. Multivariate analysis identified severe-symptom group (β coefficient [β]=0.62, 95% confidence interval [CI]: 0.21-1.03), rural residence (β=0.21, 95% CI: 0.04-0.39), GOLD (β=0.23, 95% CI: 0.07-0.39), mMRC (β=0.17, 95% CI: 0.03-0.31), and CAT score (β=0.04, 95% CI: 0.02-0.06) associated with frailty.
Patients with stable COPD can be categorized based on patient-reported outcomes, with differences in demographic and disease characteristics across subgroups. Patients with severe COPD symptoms revealed higher levels of frailty compared to those with low symptoms.
慢性阻塞性肺疾病（COPD）在个体间表现出异质性症状特征。本研究旨在根据生理、心理和环境症状确定稳定期COPD患者的亚组；评估其特征差异；并检验症状模式与衰弱的关联。
我们分析了一项队列研究第二波的数据，该研究涉及因急性加重住院6个月后重新评估的COPD患者。使用FRAIL量表和改良的慢性阻塞性肺疾病患者报告结局量表（mCOPD-PRO）测量衰弱和患者报告的结局。潜在剖面分析根据mCOPD-PRO症状模式确定亚组。使用事后趋势分析和卡方趋势检验评估症状严重程度亚组之间的差异。多项逻辑回归量化亚组之间差异的大小。通过线性回归检验亚组、临床因素与衰弱之间的关系。
在308例稳定期COPD患者中，确定了三个亚组：“低症状组”（27.9%）、“中度症状组”（51.3%）和“重度症状组”（20.8%）。体重指数、慢性阻塞性肺疾病全球倡议（GOLD）分期、COPD评估测试（CAT）评分、改良医学研究委员会（mMRC）评分和身体活动在症状严重程度增加的亚组中呈现出显著的线性趋势。衰弱评分差异显著：低症状组为0.50±0.78，中度症状组为1.34±0.96，重度症状组为2.72±0.9。多变量分析确定重度症状组（β系数[β]=0.62，95%置信区间[CI]：0.21-1.03）、农村居住（β=0.21，95%CI：0.04-0.39）、GOLD分期（β=0.23，95%CI：0.07-0.39）、mMRC评分（β=0.17，95%CI：0.03-0.31）和CAT评分（β=0.04，95%CI：0.02-0.06）与衰弱相关。
稳定期COPD患者可根据患者报告的结局进行分类，各亚组在人口统计学和疾病特征方面存在差异。与低症状患者相比，重度COPD症状患者的衰弱水平更高。
