Clinical phenotypes based on clinical prognostic factors in patients with secondary hip osteoarthritis: preliminary findings from a prospective cohort study
Clinical phenotypes based on clinical prognostic factors in patients with secondary hip osteoarthritis: preliminary findings from a prospective cohort study
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基于继发性髋骨关节炎患者临床预后因素的临床表型：前瞻性队列研究的初步结果
DOI：
10.1007/s10067-020-04988-7
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发表时间：
2020
影响因子：
3.4
通讯作者：
Ichihashi N.
中科院分区：
文献类型：
--
作者：
Tateuchi H;Akiyama H;Goto K;So K;Kuroda Y;Ichihashi N.
目的：近来，一些髋关节骨关节炎（OA）进展的临床预后因素，如脊柱对线不良、脊柱活动度降低和每日累积髋关节负荷过大已被确定。本研究的目的是确定继发性髋关节OA患者的临床预后因素的基础上，使用前瞻性队列研究的数据，并定义每个phenotype.MethodsFifty患者的临床特征。使用以下髋关节OA进展的潜在预后因素进行两步聚类分析，以确定表型：站立时的脊柱倾斜度、胸腰椎活动度、每日累积髋关节力矩和基线时的最小关节间隙宽度（JSW）。全面的基本和临床特征采用bootstrap法比较不同表型患者的年龄、体重指数、髋关节疼痛、Harris髋关节评分、JSW、影像学髋关节形态学、髋关节损伤、脊柱排列和活动度以及步态相关变量，以及12个月内进展者的比例结果鉴定出三种表型，每种表型的特征如下（P< 0.05）：表型1（30%）-年龄相对较小，每日累积髋关节负荷较高;表型2（42.0%）-年龄相对较大，JSW降低，脊柱活动度较低;表型3（28.0%）-胸椎排列改变，脊柱（尤其是胸椎）活动度较低。表型之间的进展者的比率没有统计学显著差异。这些特点仍然调整后的年龄。结论三个表型具有相似的进展风险。这一发现将有助于设计针对每种表型的治疗方案，以预防髋关节OA进展。关键点·基于临床预后因素，确定了具有相似进展风险的三种表型。·表型1的特征是年龄较小和每日累积髋关节负荷较高。·表型2是相对年老的，并且具有减少的JSW和较少的脊柱活动性。表型3改变了胸椎的排列和胸椎的活动度。
ObjectivesRecently, several clinical prognostic factors for hip osteoarthritis (OA) progression such as spinal malalignment, reduced spinal mobility, and excessive daily cumulative hip loading have been identified. This study aimed to identify clinical phenotypes based on clinical prognostic factors in patients with secondary hip OA using data from prospective cohort studies and to define the clinical features of each phenotype.MethodsFifty patients participated. Two-step cluster analysis was performed to identify the phenotypes using the following potential prognostic factors for hip OA progression: spinal inclination in standing, thoracolumbar spine mobility, daily cumulative hip moment, and minimum joint space width (JSW) at baseline. Comprehensive basic and clinical features (age, body mass index, hip pain, Harris hip score, JSW, radiographic hip morphology, hip impairments, spinal alignment and mobility, and gait-related variables) and ratio of progressors in 12 months were compared among the phenotypes using bootstrap method (unadjusted and adjusted for age).ResultsThree phenotypes were identified and each phenotype was characterized as follows (P< 0.05): phenotype 1 (30%)—relatively young age and higher daily cumulative hip loading; phenotype 2 (42.0%)—relatively older age, reduced JSW, and less spinal mobility; and phenotype 3 (28.0%)—changed thoracic spine alignment and less spinal (especially in the thoracic spine) mobility. The ratio of progressors among the phenotypes was not statistically significantly different. These characteristics remained after adjustment for age.ConclusionThree phenotypes with similar progression risk were identified. This finding will help in designing treatment tailored to each phenotype for hip OA progression prevention.Key Points• Three phenotypes with similar progression risk were identified based on clinical prognostic factors.• Phenotype 1 was characterized by young age and higher daily cumulative hip loading.• Phenotype 2 was relatively old age and had reduced JSW and less spinal mobility.• Phenotype 3 had changed thoracic spine alignment and less thoracic spine mobility.