应用主成分和聚类分析法探索慢性阻塞性肺疾病表型的临床研究

摘要

目的：探索慢性阻塞性肺疾病（COPD）患者不同临床表型，为实现个体化诊治提供临床依据。方法对2011年10月-2012年3月南昌大学第二附属医院呼吸内科157例 COPD 患者，应用主成分分析（PCA）和聚类分析法识别不同 COPD 亚组分类。结果122例研究对象参与分析，其中94例为男性患者；年龄为53~89岁，平均年龄为（72±7）岁。PCA 分析出三个主要因子，在所有因子中累积方差贡献率约为73.1%。在 PCA 的基础上进行聚类分析将患者分成4类：（1）相对老年患者，吸烟指数高，中重度气流受限，重度呼吸困难，合并症少，炎症指标明显升高；（2）老年患者，中度气流受限，中度呼吸困难，吸烟指数低，合并症多，炎症指标明显升高；（3）与第2类比较，第3类为相对年轻患者，重度气流受限，重度呼吸困难，合并症少，吸烟指数低，炎症指标轻度升高；（4）与第1类比较，第4类患者吸烟指数低，合并症少，轻度呼吸困难，炎症指标升高不明显。结论气流受限程度相似的COPD 患者可能有不一样的年龄、临床表现、合并症及预后，多维分析 COPD 患者，实行个体化管理，有助于提高患者治疗的效果。%Objective To explore different clinical phenotypes of COPD patients and provide clinical evidence for indi-vidualized diagnosis and treatment. Methods The COPD phenotypes of 157 patients were identified and analyzed by principal component analysis(PCA)and cluster analysis in the respiratory department of the Second Affiliated Hospital of Nanchang Uni-versity between 2011 October and 2012 March. Results Data of 122 subjects were analyzed:94 subjects were male,the average age was(72 ± 7)years(range 53 - 89 years). Three main components were identified by PCA,which accounted for 73. 1% of the variance among all the components. The subjects were divided into four phenotypes by cluster analysis on the basis of PCA:(1)relatively old patients,high smoking index,moderate or severe airflow limitation,severe dyspnea,low co - morbidity, apparent increased inflammation indicators;(2)old patient,moderate airflow limitation,moderate dyspnea,low smoking in-dex,high co - morbidity,apparent increased inflammation indicators;(3)relatively younger than phenotype 2,severe airflow limitation,severe dyspnea,low co - morbidity,low smoking index,mild increased inflammation indicators;(4)lower smok-ing index than phenotype 1,low co - morbidity,mild dyspnea,no apparent increased inflammation indicators. Conclusion COPD patients with similar airflow limitation severity could be of different age,manifestation,co - morbidity and progno-sis. Multidimensional analysis of COPD patients and individualized management are helpful for promoting the effect of treatment.