Lanting Rosanne, van den Heuvel Edwin R, Werker Paul M N
Department of Plastic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
Department of Mathematics and Computer Science, Eindhoven University of Technology, Eindhoven, The Netherlands.
J Hand Surg Am. 2016 Mar;41(3):354-61; quiz 361. doi: 10.1016/j.jhsa.2015.10.027. Epub 2016 Jan 16.
The course of Dupuytren disease (DD) is thought to be progressive; however, the course differs for each patient. The purpose of this study was to study the rate and pattern of progression of DD.
We prospectively analyzed the course of DD at intervals of 3 to 6 months in 247 Dutch participants with primary DD by measuring the surface area of nodules and cords and the total passive extension deficit. The association between surface area and Tubiana stage was tested with generalized estimating equations. Latent class models were used to study different clusters in changes regarding the course of the disease.
The variance in disease course between participants was large. Regarding the change in surface area (in all fingers) and total passive extension deficit (in the ring and little finger), different clusters were observed. Progression of disease was seen but there were also signs of stability and even regression. Patients with a smaller surface area at baseline were more likely to exhibit regression.
This study showed that DD is not always progressive and that up to 75% of patients have a different short-term disease course, such as stability or even regression of disease. This should be taken into account when evaluating the effects of treatment for early-phase DD and in the design of future studies. Furthermore, this information may be useful when counseling patients.
TYPE OF STUDY/LEVEL OF EVIDENCE: Prognostic II.
人们认为掌腱膜挛缩症（DD）的病程是渐进性的；然而，每位患者的病程各不相同。本研究的目的是研究DD的进展速率和模式。
我们对247名患有原发性DD的荷兰参与者每隔3至6个月进行一次前瞻性分析，通过测量结节和条索的表面积以及总的被动伸展缺陷来评估DD的病程。使用广义估计方程检验表面积与图比阿纳分期之间的关联。使用潜在类别模型研究疾病病程变化中的不同聚类。
参与者之间的疾病病程差异很大。关于表面积（所有手指）的变化以及总的被动伸展缺陷（环指和小指），观察到了不同的聚类。疾病有进展，但也有稳定甚至消退的迹象。基线时表面积较小的患者更有可能出现疾病消退。
本研究表明，DD并非总是渐进性的，高达75%的患者有不同的短期疾病病程，如疾病稳定甚至消退。在评估早期DD治疗效果以及设计未来研究时应考虑到这一点。此外，这些信息在为患者提供咨询时可能会有所帮助。
研究类型/证据水平：预后性研究II级。
