Farragher Tracey M, Lunt Mark, Bunn Diane K, Silman Alan J, Symmons Deborah P M
Arc Epidemiology Unit, The University of Manchester, Stopford Building, Oxford Road, Manchester M13 9PT, and Norfolk Arthritis Register, Norfolk and Norwich University Hospital, UK.
Ann Rheum Dis. 2007 Apr;66(4):486-92. doi: 10.1136/ard.2006.056390. Epub 2006 Nov 7.
To investigate the predictive value of early functional disability in patients with inflammatory polyarthritis (IP), for all-cause and cardiovascular disease (CVD) mortality.
1010 subjects with new-onset IP from the Norfolk Arthritis Register were studied. All were seen at baseline and at 1 year. Health Assessment Questionnaire (HAQ) scores were obtained at both time points. Vital status at 10 years from registration was established through central records. Mortality (all-cause and CVD) per 1000 person-years were calculated by HAQ stratum (HAQ scores<1, 1-2 and>or=2). The predictive value of HAQ (per unit increase) at the two time points, adjusted for age at onset of symptom, sex and other factors found to predict mortality, was assessed using Cox regression models. The analysis was repeated for those who satisfied the 1987 American College of Rheumatology criteria for rheumatoid arthritis (RA) by 5 years.
By 10 years, 171 (16.9%) subjects had died. 89 deaths (52%) were attributed to CVD. Mortality was greatest in the highest HAQ group at both time points. Following adjustment for other predictors, HAQ score at year 1 remained a significant predictor of all-cause mortality (HR 1.46; 95% CI 1.15 to 1.85) and CVD mortality (HR 1.49; 95% CI 1.12 to 1.97). The predictive value of HAQ at year 1 was similar in the RA subgroup.
Our data show that at 1 year of follow-up, HAQ score is an important independent predictor of subsequent all-cause and CVD mortalities in people with IP and RA. Baseline HAQ scores are of less value.
探讨炎症性多关节炎（IP）患者早期功能残疾对全因死亡率和心血管疾病（CVD）死亡率的预测价值。
对诺福克关节炎登记处的1010例新发IP患者进行研究。所有患者均在基线期和1年时接受检查。在两个时间点均获取健康评估问卷（HAQ）评分。通过中央记录确定登记后10年的生命状态。按HAQ分层（HAQ评分<1、1 - 2和≥2）计算每1000人年的死亡率（全因和CVD）。使用Cox回归模型评估两个时间点HAQ（每单位增加）的预测价值，并对症状出现时的年龄、性别和其他已发现可预测死亡率的因素进行校正。对5年后符合1987年美国风湿病学会类风湿关节炎（RA）标准的患者重复进行分析。
到10年时，171例（16.9%）患者死亡。89例死亡（52%）归因于CVD。在两个时间点，HAQ最高组的死亡率最高。在对其他预测因素进行校正后，第1年的HAQ评分仍然是全因死亡率（HR 1.46；95% CI 1.15至1.85）和CVD死亡率（HR 1.49；95% CI 1.12至1.97）的显著预测因素。在RA亚组中，第1年HAQ的预测价值相似。
我们的数据表明，在随访1年时，HAQ评分是IP和RA患者随后全因死亡率和CVD死亡率的重要独立预测因素。基线HAQ评分的价值较小。
