Changes in forced vital capacity over time in systemic sclerosis: application of group-based trajectory modelling
Changes in forced vital capacity over time in systemic sclerosis: application of group-based trajectory modelling
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DOI：
10.1093/rheumatology/kev016
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发表时间：
2015-08-01
期刊：
影响因子：
5.5
通讯作者：
Simms, Robert W.
中科院分区：
文献类型：
--
作者：
Man, Ada;Davidyock, Todd;Simms, Robert W.
客观的。用力肺活量 (FVC) 加速下降影响超过 50% 的 SSc 患者，但有关这种变化的变异性和决定因素的数据很少。我们试图确定 SSc 患者 12 年期间的 FVC 轨迹及其相关变量。方法。回顾性收集临床和肺功能数据。具有三个或更多 FVC 值的 SSc 患者被纳入。基于组的建模用于将相似的 FVC 模式聚类成轨迹。使用多项逻辑回归将基线变量与轨迹相关联。将每个轨迹作为时变协变量检查 CYC 对 FVC 的影响。结果。在 254 名 SSc 患者中，我们确定了七种不同的 FVC 轨迹：极低缓慢下降 (5.5%)、极低改善 (13.8%)、低快速下降 (9.5%)、低稳定 (19.7%)、低正常改善 (31.1%)、正常改善 (16.1%) 和正常稳定 (4.3%)。与参考轨迹相比，年龄较小以及基线时存在肺动脉高压、间质性肺疾病和呼吸短促显着增加了轨迹下降的可能性（低正常改善）。 CYC 与低快速下降轨迹中的 FVC 改善相关。结论。 SSc 中的 FVC 过程变化很大，即使那些基线 FVC 较低的患者也能经历改善和稳定。轨迹建模能够识别最有可能经历 FVC 下降的 SSc 患者，因此可能成为患者管理和临床试验设计的有用工具。
Objective. An accelerated rate of decline in forced vital capacity (FVC) affects > 50% of patients with SSc but data on the variability and determinants of this change are scarce. We sought to identify trajectories of FVC and their associated variables in SSc patients over a 12-year period.Methods. Clinical and pulmonary function data were retrospectively collected. SSc patients with three or more FVC values were included. Group-based modelling was used to cluster similar FVC patterns into trajectories. Baseline variables were associated with the trajectories using multinomial logistic regression. The effect of CYC on FVC was examined with each trajectory as a time-varying covariate.Results. In 254 SSc patients we identified seven distinct FVC trajectories: very low slow decline (5.5%), very low improve (13.8%), low fast decline (9.5%), low stable (19.7%), low-normal improve (31.1%), normal improve (16.1%) and normal stable (4.3%). Younger age and the presence of pulmonary hypertension, Interstitial lung disease and shortness of breath at baseline significantly increased the odds of declining trajectories vs the reference trajectory (low-normal improve). CYC was associated with FVC improvement in the low fast decline trajectory.Conclusion. The course of FVC in SSc was highly variable, with improvement and stability experienced even by those with low baseline FVC. Trajectory modelling was able to identify SSc patients who were most likely to experience FVC decline and thus could be a useful tool for patient management as well as clinical trial design.