Center for Chronic Immunodeficiency (CCI), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Section of Health Care Research and Rehabilitation Research (SEVERA), Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
Clin Exp Immunol. 2019 Apr;196(1):76-85. doi: 10.1111/cei.13252. Epub 2019 Jan 13.
Common variable immunodeficiency (CVID) is a complex disease with various influences on perceived health, which correlate with different outcomes, including new morbidity and mortality. Our hypothesis was that CVID patients fall into distinct clusters of perceived health which can inform care. Ward hierarchical cluster analysis and K-means cluster analysis were performed on data of 209 CVID patients to identify subgroups regarding their self-reported physical and mental health status, assessed by the physical (PCS) and mental component scores (MCS) of the Short Form-12 (SF-12). Four clusters of CVID-patients were identified. Cluster 1 was the largest cluster, characterized by a relatively high physical and mental health status (44·0%). In contrast, cluster 2 (21·1%) included patients with low physical and mental health status. Clusters 3 and 4 were mixed groups with high mental and low physical health (15·8%) and vice versa (19·1%). Significant differences between the clusters were found for patient-reported outcomes such as work ability and health literacy, but not for CVID-associated complications such as enteropathy, interstitial lung disease, granulomatosis, lymphadenopathy and autoimmune cytopenia or laboratory parameters such as immunoglobulin levels or B cell-based classification. The results suggest different subgroups of CVID patients with contrasting individual needs which, surprisingly, did not differ in clinical or laboratory characteristics. The main finding of this study is that patients with CVID fall into four distinct clusters according to perceived health, which are largely independent of CVID complications.
普通变异性免疫缺陷症(CVID)是一种复杂的疾病,对感知健康有多种影响,这些影响与不同的结果相关,包括新的发病率和死亡率。我们的假设是,CVID 患者可以分为不同的感知健康群体,这可以为治疗提供信息。对 209 名 CVID 患者的数据进行了 ward 层次聚类分析和 K-means 聚类分析,以确定其自我报告的身体和心理健康状况的亚组,这些状况通过 12 项简短健康调查问卷(SF-12)的身体(PCS)和心理成分评分(MCS)来评估。确定了 4 个 CVID 患者亚群。第 1 个亚群是最大的亚群,其身体和心理健康状况相对较高(44.0%)。相比之下,第 2 个亚群(21.1%)包括身体和心理健康状况较低的患者。第 3 个和第 4 个亚群是混合群体,具有较高的心理和较低的身体健康状况(15.8%)和相反的情况(19.1%)。在患者报告的结果(如工作能力和健康素养)方面,不同亚群之间存在显著差异,但在 CVID 相关并发症(如肠病、间质性肺病、肉芽肿病、淋巴结病和自身免疫性细胞减少症)或实验室参数(如免疫球蛋白水平或基于 B 细胞的分类)方面无差异。结果表明,CVID 患者存在不同的亚组,具有不同的个体需求,而这些需求在临床或实验室特征方面并没有差异,这令人惊讶。本研究的主要发现是,根据感知健康,CVID 患者可分为四个不同的亚群,这些亚群在很大程度上与 CVID 并发症无关。