关于痛风合并症的回顾性研究:一项聚类分析
译者:任丽民 校对者:高晋芳 审核者:张莉芸
Revisiting comorbidities in gout: a cluster analysis
Abstract -IVES:The reciprocal -s between comorbidities and gout are complex. We used cluster analysis to attempt to identify different phenotypes on the basis of comorbidities in a large cohort of patients with gout.METHODS:This was a cross-
sectional multicentre study of 2763 gout patients conducted from November 2010 to May 2011. Cluster analysis was conducted separately for variables and for observations in patients, measuring proximity between variables and identifying homogeneous subgroups of patients. Variables used in both analyses were hypertension, obesity, diabetes, dyslipidaemia, heart failure, coronary heart disease, renal failure, liver disorders and cancer.RESULTS:Comorbidities were common in this large cohort of patients with gout. Abdominal obesity, hypertension, -bolic syndrome and dyslipidaemia increased with gout duration, even after adjustment for age and sex. Five clusters (C1-C5) were found. Cluster C1 (n=332, 12%) consisted of patients with isolated gout and few comorbidities. In C2 (n=483, 17%), all patients were obese, with a high prevalence of hypertension. C3 (n=664, 24%) had the greatest proportion of patients with type 2 diabetes (75%). In C4 (n=782, 28%), almost all patients presented with dyslipidaemia (98%). Finally, C5 (n=502, 18%) consisted of almost all patients with a history of cardiovascular disease and renal failure, with a high rate of patients receiving diuretics.CONCLUSIONS:Cluster analysis of comorbidities in gout allowed us to identify five different clinical phenotypes, which may reflect different pathophysiological processes in gout.
目的:痛风与其合并症之间的相互联系是复杂的。我们采用聚类分析的方法,通过分析总结大量痛风患者的合并症,达到明确其不同临床表型的目的。方法:本研究从2010年11月到2011年5月期间对2763位痛风患者进行了一项多中心性研究。分别对各种变量以及对病人的临床观测进行聚类分析,衡量各组变量之间的联系以及识别同质亚组患者。在聚类分析中的变量包括高血压,肥胖,糖尿病,血脂异常,心力衰竭,心脏病,肾功能衰竭,肝脏疾病和癌症。结果:观察对象的合并症均为常见合并症。腹型肥胖,高血压,血脂异常,代谢综合征的发生率随着痛风的持续呈增长趋势,即使排除年龄和性别的影响因素后仍是如此。最终确发现五类群体(C1-C5)。群体C1(n=332,12%)患者痛风发病和一些合并症无明显相关性。在C2(n = 483,17%)中所有患者均肥胖,有较高的高血压患病率。C3群体(n = 664,24%)中2型糖尿病的比例最大(75%)。在C4群体(n=782,28%)中几乎所有的患者均出现血脂异常(98%)。最后,C5群体(n= 502,18%)中几乎所有患者均有心血管疾病和肾功能衰竭的病史并且大多数患者接受过利尿治疗。结论:通过对痛风病人的合并症进行聚类分析,最终确定了五个不同的临床表型,这些临床表型可能反映了痛风发病的不同病理生理过程。