干燥综合征患者唾液腺增大、C3和/或C4降低是发生淋巴瘤的独立危险因素
发表者：金晶
日期：2015-03-04
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摘要 目的：综合应用常规临床及血清学检查结果，制订并验证用于预测原发性干燥综合症(pSS)进展为B细胞非霍奇金淋巴瘤(B细胞NHL)的实用临床标准。
方法：本研究回顾了563名pSS患者的人口学、临床及免疫学资料。通过多因素logistic回归分析来确定淋巴瘤的独立危险因子，并建立倾向指数以区分B细胞NHL高风险患者。通过重复抽样来验证该模型的可靠性。
结果：在这563名pSS患者里，纳入了387名符合欧美共识标准的患者(12名患B细胞NHL，375名未患B细胞NHL)。结果显示唾液腺增大(P = 0.001)、C3 (P = 0.035) 和/或C4水平降低(P = 0.021)及病程(P = 0.001)是pSS患者发生B细胞NHL的独立危险因素(表1)。倾向积分的最优阈值为Y = 4.26，诊断B细胞NHL患者的敏感性为78%，特异性为95%。留一法交叉验证的预测误差为6%，采用自抽样法获得的敏感性和特异性中位数分别为71%和95%。
结论：本临床预测模型能够鉴定出pSS患者当中的B细胞NHL高危人群，并且具有较好的辨别能力和内、外部可重复性。
附原文：OBJECTIVE: To develop and validate a practical predictionrule for the progression from primarySjögren'ssyndrome (pSS) to B cell non-Hodgkin's lymphoma (B cell NHL) based on the combination of routinely available clinical and serological disease variables.METHODS: The case records of 563 patients with pSS were reviewed, and their demographic, clinical, and immunologic features were collected. Multivariate logistic regression analysis was performed to identify independent risk factors for lymphomadevelopment and to create a propensity score for discrimination between patients at risk of B cell NHL and those patients not at risk. The model was internally validated by resampling procedures.RESULTS: Out of 563 patients with pSS, 387 fulfilling the American European Consensus Group criteria (12 with B cell NHL, 375 without B cell NHL) were included in our study. Salivary gland enlargement (p = 0.001), low C3 (p = 0.035) and/or C4 levels (p = 0.021), and disease duration (p = 0.001) were identified as independent risk factors for B cell NHL in pSS. The optimal threshold of the propensity score was determined at Y = 4.26, which allowed us to identify patients who develop B cell NHL with a sensitivity of 78% and specificity of 95%. The leave-one-out cross-validated prediction error was 6%, and the median bootstrapped sensitivity and specificity were 71% and 95%, respectively.CONCLUSION: We created a "bedside" prediction model for the identification of patients with pSS who are at risk for B cell NHL, which revealed an excellent discriminative ability and a good internal and external reproducibility.
引自：Baldini C, Pepe P, Luciano N, et al. A clinical prediction rule for lymphoma development in primary Sjögren's syndrome. J Rheumatol. 2012 Apr;39(4):804-8. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）
方法：本研究回顾了563名pSS患者的人口学、临床及免疫学资料。通过多因素logistic回归分析来确定淋巴瘤的独立危险因子，并建立倾向指数以区分B细胞NHL高风险患者。通过重复抽样来验证该模型的可靠性。
结果：在这563名pSS患者里，纳入了387名符合欧美共识标准的患者(12名患B细胞NHL，375名未患B细胞NHL)。结果显示唾液腺增大(P = 0.001)、C3 (P = 0.035) 和/或C4水平降低(P = 0.021)及病程(P = 0.001)是pSS患者发生B细胞NHL的独立危险因素(表1)。倾向积分的最优阈值为Y = 4.26，诊断B细胞NHL患者的敏感性为78%，特异性为95%。留一法交叉验证的预测误差为6%，采用自抽样法获得的敏感性和特异性中位数分别为71%和95%。
结论：本临床预测模型能够鉴定出pSS患者当中的B细胞NHL高危人群，并且具有较好的辨别能力和内、外部可重复性。
附原文：OBJECTIVE: To develop and validate a practical predictionrule for the progression from primarySjögren'ssyndrome (pSS) to B cell non-Hodgkin's lymphoma (B cell NHL) based on the combination of routinely available clinical and serological disease variables.METHODS: The case records of 563 patients with pSS were reviewed, and their demographic, clinical, and immunologic features were collected. Multivariate logistic regression analysis was performed to identify independent risk factors for lymphomadevelopment and to create a propensity score for discrimination between patients at risk of B cell NHL and those patients not at risk. The model was internally validated by resampling procedures.RESULTS: Out of 563 patients with pSS, 387 fulfilling the American European Consensus Group criteria (12 with B cell NHL, 375 without B cell NHL) were included in our study. Salivary gland enlargement (p = 0.001), low C3 (p = 0.035) and/or C4 levels (p = 0.021), and disease duration (p = 0.001) were identified as independent risk factors for B cell NHL in pSS. The optimal threshold of the propensity score was determined at Y = 4.26, which allowed us to identify patients who develop B cell NHL with a sensitivity of 78% and specificity of 95%. The leave-one-out cross-validated prediction error was 6%, and the median bootstrapped sensitivity and specificity were 71% and 95%, respectively.CONCLUSION: We created a "bedside" prediction model for the identification of patients with pSS who are at risk for B cell NHL, which revealed an excellent discriminative ability and a good internal and external reproducibility.
引自：Baldini C, Pepe P, Luciano N, et al. A clinical prediction rule for lymphoma development in primary Sjögren's syndrome. J Rheumatol. 2012 Apr;39(4):804-8. （注：干燥综合症病人或亲属可加QQ群交流，群号： 118194945 ，本网站站长私人微信号： ssgzz88 ）