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集群分析确定了新的现实世界肺病-肺高血压亚现象:对治疗反应的影响

Shelsey W Johnson^1,2,3, Rui-Sheng Wang⁴, Michael R Winter⁵

¹VA Boston Healthcare System, Boston, MA, USA.

ERJ open research

|May 21, 2024

概括

集群分析揭示了第三组肺高血压 (PH) 中不同的患者亚组,确定了新的表型. 这些亚型表现出不同的临床轨迹,并且可能对肺动脉高血压 (PAH) 治疗有不同的反应.

科学领域:

肺高血压研究肺高血压研究
心肺医学心肺医学
在医疗保健中的数据科学.

背景情况:

与肺部疾病或缺氧相关的肺高血压 (PH) (3组PH) 呈现出显著的临床异质性.
之前的临床试验重用肺动脉高血压 (PAH) 治疗在3组PH已经产生了不一致的结果.
强大的患者表型定型对于在异质PH群体内识别治疗响应子组至关重要.

研究的目的:

调查集群分析的潜力,以确定3组PH.内不同的亚现象类型.
为了确定已识别的子类型是否表现出不同的临床结果和治疗反应.
探索高级表型化在指导第三组PH的治疗策略中的实用性.

主要方法:

K-means集群分析应用于美国退伍军人国家队列,其中包括3组PH.
使用了两个模型:一个包容性模型 (n=196) 和一个血液动力学模型 (n=112) 使用右心脏导管数据.
主要结局是器官衰竭或全因死亡率;探索性分析评估了集群内治疗效应.

主要成果:

在包容性和血液动力学模型中,确定了三个不同的患者群.
在血液动力学模型中,集群在呼吸衰竭或死亡风险上有显著差异,其中一个集群显示危险增加6.1倍.
探索性分析表明,集群分配预测了治疗反应 (p=0.006).

结论:

集群分析成功地确定了具有明显临床轨迹的第三组PH患者的新型,现实世界的亚现象型.
这些发现表明,先进的表型定型可以发现具有差异性预后和对治疗的潜在反应的患者子组.
未来的研究应该利用集群分析来确定适应现有的肺血管扩张疗法的特定子组.

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