血小板增多症作为风湿性多肌痛的一个预后因素：通过聚类分析确定的特征
Thrombocytosis as a prognostic factor in polymyalgia rheumatica: characteristics determined from cluster analysis.
作者信息
Hayashi Keigo, Ohashi Keiji, Watanabe Haruki, Sada Ken-Ei, Shidahara Kenta, Asano Yosuke, Asano Sumie Hiramatsu, Yamamura Yuriko, Miyawaki Yoshia, Morishita Michiko, Matsumoto Yoshinori, Kawabata Tomoko, Wada Jun
机构信息
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Kita-ku, Okayama, Japan.
Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Kitaku, Okayama City 700-8558, Japan.
出版信息
Ther Adv Musculoskelet Dis. 2019 Jul 18;11:1759720X19864822. doi: 10.1177/1759720X19864822. eCollection 2019.
BACKGROUND
This study aimed to identify the clinical subgroups of polymyalgia rheumatica (PMR) using cluster analysis and compare the outcomes among the identified subgroups.
METHODS
We enrolled patients with PMR who were diagnosed at Okayama University Hospital, Japan between 2006 and 2017, met the 2012 European League Against Rheumatism/American College of Rheumatology provisional classification criteria for PMR, and were treated with glucocorticoids. Hierarchical cluster analysis using variables selected by principal component analysis was performed to identify the clusters. Subsequently, the outcomes among the identified clusters were compared in the study. The primary outcome was treatment response at 1 month after commencement of treatment. The secondary outcome was refractory clinical course, which was defined as the requirement of additional treatments or relapse during a 2-year observational period.
RESULTS
A total of 61 consecutive patients with PMR were enrolled in the study. Their mean age was 71 years, and 67% were female. Hierarchical cluster analysis revealed three distinct subgroups: cluster 1 ( = 14) was characterized by patients with thrombocytosis (all patients showed a platelet count of >45 × 10⁴/µl), cluster 2 ( = 38), by patients without peripheral arthritis, and cluster 3 ( = 9), by patients with peripheral arthritis. The patients in cluster 1 achieved treatment response less frequently than those in cluster 2 (14% 47%, = 0.030). Refractory cases were more frequent in cluster 1 than in cluster 2; however, no significant difference was noted (71% 42%, = 0.06).
CONCLUSIONS
Thrombocytosis could predict the clinical course in patients with PMR.
背景
本研究旨在通过聚类分析确定风湿性多肌痛（PMR）的临床亚组，并比较所确定亚组之间的结局。
方法
我们纳入了2006年至2017年期间在日本冈山大学医院被诊断为PMR、符合2012年欧洲抗风湿病联盟/美国风湿病学会PMR临时分类标准且接受糖皮质激素治疗的患者。使用主成分分析选择的变量进行层次聚类分析以确定聚类。随后，在研究中比较所确定聚类之间的结局。主要结局是治疗开始后1个月的治疗反应。次要结局是难治性临床病程，定义为在2年观察期内需要额外治疗或复发。
结果
本研究共纳入61例连续的PMR患者。他们的平均年龄为71岁，67%为女性。层次聚类分析揭示了三个不同的亚组：聚类1（n = 14）的特征是血小板增多症患者（所有患者血小板计数>45×10⁴/µl），聚类2（n = 38）的特征是无外周关节炎的患者，聚类3（n = 9）的特征是有外周关节炎的患者。聚类1中的患者比聚类2中的患者更不频繁地实现治疗反应（14%对47%，P = 0.030）。聚类1中的难治性病例比聚类2中更频繁；然而，未观察到显著差异（71%对42%，P = 0.06）。
结论
血小板增多症可预测PMR患者的临床病程。
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