基于症状表型分析的中老年不同表型下呼吸道感染患者临床特征及结局研究-现代医学

基于症状表型分析的中老年不同表型下呼吸道感染患者临床特征及结局研究

单位：南京市中心医院呼吸与危重症医学科, 江苏南京 210000

分类号：R56

出版年·卷·期（页码）：2026·54·第三期（404-412）

摘要：

目的：基于潜在类别分析(LCA)识别中老年社区获得性肺炎(CAP)患者的症状表型，并探讨其与临床特征、生物学指标及预后的关联。方法：前瞻性纳入272例中老年CAP患者。通过LCA对11项关键临床症状进行建模以识别同质亚组。比较不同表型在人口学特征、炎症标志物、肺功能、合并症、病原学分布、住院期间临床结局及出院后30 d随访结局(再入院、症状缓解时间等)方面的差异。结果：LCA确定3种具有显著差异的症状表型(熵=0.85)：表型1(典型炎症型，占40.4%)，以高热、咳大量黄脓痰和局限性湿啰音为特征；表型2(气道负荷加重型，占35.3%)，以中重度气促、广泛哮鸣音和慢性气道疾病背景为主；表型3(隐匿虚弱型，占24.3%)，以极度乏力、食欲减退等非特异性症状及高合并症负担为特点。3种表型在宿主反应方面差异显著：表型1的炎症水平最高(CRP中位数152.4 mg·L^-1)，表型2的基线肺功能最差(FEV₁%为56.8)，表型3的营养状态最差(白蛋白30.1 g·L^-1)且年龄最大(77.5岁)。临床结局方面：表型1的重症化风险最高(ICU入住率28.2%)，表型2的住院时间最长(中位住院时间13.1 d)。30 d随访显示，表型2的再入院率(37.5%)及急诊就诊率(16.7%)最高，而表型3的症状缓解时间最长(中位症状缓解时间10 d)。结论：中老年CAP患者存在3种异质性症状表型，分别对应不同的病理生理机制(强烈炎症反应、急性气流受限加重、虚弱状态)。这些表型与独特的宿主特征、病原学模式和短期预后显著相关。本研究使用的表型判别参数和计算公式，为临床实现基于表型的个体化精准管理提供了可操作的工具和重要依据。

Objective: To identify distinct symptom-based phenotypes in middle-aged and older patients with community-acquired pneumonia(CAP) using latent class analysis(LCA), and to investigate their associations with clinical characteristics, biomarkers, and prognosis.Methods: This prospective cohort study enrolled 272 middle-aged and older patients with CAP. LCA was applied to model 11 key clinical symptoms to identify homogeneous subgroups. The identified phenotypes were compared regarding demographics, inflammatory markers, pulmonary function, comorbidities, etiological distribution, in-hospital outcomes, and 30-day follow-up outcomes(readmission, symptom resolution time, etc.).Results: LCA identified three distinct symptom phenotypes(entropy=0.85): phenotype 1(classic inflammatory, 40.4%) characterized by high fever, profuse purulent sputum, and localized crackles; phenotype 2(airway-dominant exacerbation, 35.3%) characterized by moderate-to-severe dyspnea, widespread wheezing, and background of chronic airway disease; phenotype 3(cryptic frailty, 24.3%) characterized by nonspecific symptoms including extreme fatigue and poor appetite, with high comorbidity burden. Significant differences in host responses were observed among the three phenotypes: phenotype 1 exhibited the highest inflammatory level [median C-reactive protein(CRP) 152.4 mg·L^-1], phenotype 2 had the poorest baseline lung function(FEV₁% predicted 56.8%), and phenotype 3 showed the poorest nutritional status(albumin 30.1 g·L^-1) and oldest age(77.5 years). Regarding clinical outcomes, phenotype 1 had the highest risk of severe disease(ICU admission rate 28.2%), phenotype 2 had the longest hospital stay(13.1 d). At 30-day follow-up, phenotype 2 had the highest readmission rate(37.5%) and emergency department revisit rate(16.7%), while phenotype 3 had the longest symptom resolution time(median 10 days).Conclusion: Middle-aged and older patients with CAP exhibit three heterogeneous symptom phenotypes, corresponding to distinct pathophysiological mechanisms(intense inflammatory response, acute-on-chronic airflow limitation, and frail state). These phenotypes are significantly associated with specific host characteristics, etiological patterns, and short-term prognosis. The phenotype discrimination parameters and calculation formula provided in this study offer actionable empirical tools and important evidence for implementing phenotype-based individualized precision management in clinical practice.

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