Study on the identification of chronic obstructive pulmonary disease symptom clusters and their subgroups

doi:10.19983/j.issn.2096-8493.20220016

Abstract

Abstract:

Objective: To determine the composition of symptom clusters according to the incidence of different symptoms in chronic obstructive pulmonary disease (COPD) patients. Based on the intensity of experiences for different symptoms in patients within symptom clusters, we can identify the subgroups of symptom clusters and provide ideas for developing personalized clinical management strategies. Methods: A total of 165 COPD patients hospitalized in Zaozhuang Tumour Hospital of Shandong Province from August 2020 to August 2021 were selected. General data questionnaire and Memory symptom rating scale were used to investigate the severity of symptoms. Exploratory factor analysis was performed to analyze the composition of symptom clusters based on symptoms with incidences of 30% or more, and systematic cluster analysis was used to identify subgroups of each symptom cluster based on the score of the obtained symptom clusters. A total of 165 questionnaires were issued with convenience sampling method, and all of them were effectively retrieved. Results: The five most common symptoms in hospitalized COPD patients were shortness of breath (87.27%, 144/165), cough (84.85%,140/165), anenergia (57.58%,95/165), dry mouth (51.52%,85/165), drowsy (46.06%,76/165). Factor analysis identified three symptom clusters: affective symptom cluster, cough-fatigue symptom cluster and pain-shortness of breath symptom cluster, and the cumulative variance contribution rate was 56.34%. Cluster analysis showed that there were differences in symptom experiences among patients in the three symptom clusters, and two symptom sub-groups were identified for each symptom cluster. Conclusion: COPD patients experience complex symptoms that are correlated and present as clusters of symptoms. Patients experience different intensities of symptoms in the cluster, which can be divided into subgroups for symptom clusters. The identification of symptom clusters and their subgroups can provide a basis for medical staff to comprehensively evaluate the condition and formulate individualized intervention measures in advance, thus promote the recovery of patients to a greater extent.

Key words: Pulmonary disease,chronic obstructive, Signs and symptoms, Respiratory, Cluster analysis

CLC Number:

R563

XU Yan-song, LIU Qing-hua, QIU Xiao-ting. Study on the identification of chronic obstructive pulmonary disease symptom clusters and their subgroups[J]. Journal of Tuberculosis and Lung Disease , 2022, 3(3): 203-208. doi: 10.19983/j.issn.2096-8493.20220016

Figures/Tables 6

References 18

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症状	患者例数 (发生率,%)	症状严重程度 [分,M(Q₁,Q₃)]
气促	144(87.27)	3.0(2.0,3.0)
咳嗽	140(84.85)	2.0(1.0,3.0)
精力不足	95(57.58)	2.0(0.0,2.0)
口干	85(51.52)	1.0(0.0,2.0)
感到昏昏欲睡/易困	76(46.06)	0.0(0.0,2.0)
担忧	70(42.42)	0.0(0.0,2.0)
难以入睡	66(40.00)	0.0(0.0,2.0)
烦躁	61(36.97)	0.0(0.0,2.0)
紧张感	57(34.55)	0.0(0.0,2.0)
疼痛	57(34.55)	0.0(0.0,2.0)
便秘	48(29.09)	0.0(0.0,1.5)
手足麻木或刺痛	47(28.48)	0.0(0.0,1.0)
性功能障碍	45(27.27)	0.0(0.0,2.5)
体质量下降	44(26.67)	0.0(0.0,1.0)
皮肤瘙痒	43(26.06)	0.0(0.0,1.0)
眩晕	43(26.06)	0.0(0.0,1.0)
盗汗	42(25.45)	0.0(0.0,1.0)
纳差	42(25.45)	0.0(0.0,1.5)
腹胀	41(24.85)	0.0(0.0,0.5)
恶心	31(18.79)	0.0(0.0,0.0)
排尿困难	29(17.58)	0.0(0.0,0.0)
上肢或下肢水肿	27(16.36)	0.0(0.0,0.0)
很难集中注意力	27(16.36)	0.0(0.0,0.0)
口腔溃疡	18(10.91)	0.0(0.0,0.0)
吞咽困难	13(7.88)	0.0(0.0,0.0)
哀伤感	12(7.27)	0.0(0.0,0.0)
食物味道改变	12(7.27)	0.0(0.0,0.0)
腹泻	11(6.67)	0.0(0.0,0.0)
体质量增加	11(6.67)	0.0(0.0,0.0)
皮肤改变	10(6.06)	0.0(0.0,0.0)
我看起来不像我自己	5(3.03)	0.0(0.0,0.0)
呕吐	4(2.42)	0.0(0.0,0.0)

症状	因子1	因子2	因子3
紧张感	0.708	0.092	0.147
难以入睡	0.595	-0.063	0.411
担忧	0.867	0.149	-0.051
烦躁	0.640	0.355	0.022
精力不足	0.196	0.656	0.490
咳嗽	-0.023	0.616	-0.255
口干	0.264	0.567	0.236
感到昏昏欲睡/易困	0.137	0.727	0.144
疼痛	-0.037	0.022	0.779
气促	0.356	0.210	0.559

因子	特征值	贡献率(%)	累积贡献率(%)
1	2.27	22.73	22.73
2	1.87	18.66	41.39
3	1.50	14.95	56.34

组别	例数 (构成比,%)	紧张感 [分,M(Q₁,Q₃)]	难以入睡 [分,M(Q₁,Q₃)]	担忧 [分,M(Q₁,Q₃)]	烦躁 [分,M(Q₁,Q₃)]
症状均中组	76(46.06)	2.0(0.0,2.0)	2.0(0.0,3.0)	2.0(0.0,3.0)	2.0(2.0,2.0)
症状均低组	89(53.94)	0.0(0.0,0.0)	0.0(0.0,0.0)	0.0(0.0,0.0)	0.0(0.0,0.0)
Z值		-6.906	-6.329	-7.452	-10.382
P值		<0.001	<0.001	<0.001	<0.001

组别	例数 (构成比,%)	精力不足 [分,M(Q₁,Q₃)]	咳嗽 [分,M(Q₁,Q₃)]	口干 [分,M(Q₁,Q₃)]	感到昏昏欲睡/易困 [分,M(Q₁,Q₃)]
症状均中组	65(39.39)	2.0(2.0,3.0)	2.0(2.0,3.0)	2.0(0.0,3.0)	2.0(2.0,3.0)
中等咳嗽组、低疲乏组	100(60.61)	0.0(0.0,2.0)	2.0(1.0,3.0)	0.0(0.0,2.0)	0.0(0.0,0.0)
Z值		-8.334	-1.230	-4.450	-10.849
P值		<0.001	0.219	<0.001	<0.001