Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout.
Study for Updated Gout Classification Criteria: Identification of Features to Classify Gout.
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DOI：
10.1002/acr.22585
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发表时间：
2015-09
影响因子：
4.7
通讯作者：
Neogi T
中科院分区：
文献类型：
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作者：
Taylor WJ;Fransen J;Jansen TL;Dalbeth N;Schumacher HR;Brown M;Louthrenoo W;Vazquez-Mellado J;Eliseev M;McCarthy G;Stamp LK;Perez-Ruiz F;Sivera F;Ea HK;Gerritsen M;Scire C;Cavagna L;Lin C;Chou YY;Tausche AK;Vargas-Santos AB;Janssen M;Chen JH;Slot O;Cimmino MA;Uhlig T;Neogi T
确定哪些临床、实验室和影像特征最准确地区分痛风和非痛风。一项对连续风湿病门诊患者的横断面研究，这些患者至少有一个关节或皮下肿胀。所有患者的痛风均由有资质的检查员通过滑液或痛风抽吸显微镜进行定义。样本随机分为模型开发样本(2/3)和测试样本(1/3)。采用Logistic回归模型确定临床特征与MSU定义的痛风之间的单变量和多变量关联。为了防止最终模型的过度拟合，对回归权重进行了收缩。潜在类别分析被用来识别联合参与的模式。总共有983名患者纳入研究。痛风509例(52%)。在发展样本(n=653)中，这些特征被选为最终模型(多因素OR)、关节红斑(2.13)、行走困难(7.34)、最大疼痛时间(1.32)、2周内消退(3.58)、痛经(7.29)、曾经受累的MTP1(2.30)、当前压痛关节的位置：其他足踝(2.28)、MTP1(2.82)、血尿酸水平和GT；6 mg/dl(0.36 mm o l/L)(3.35)，超声双轮廓征(7.23)，X线糜烂或囊变(2.49)。最终的模型在测试集中表现良好，没有不匹配的证据，具有很高的识别率和预测能力。痛风患者最常见的关节类型为MTP1受累(39.4%)。为进一步评估新的痛风分类标准，已确定了10个关键的区分特征。超声表现和尿酸血症程度增加了鉴别价值，并将显著有助于更准确的分类标准。
To determine which clinical, laboratory and imaging features most accurately distinguished gout from non-gout. A cross-sectional study of consecutive rheumatology clinic patients with at least one swollen joint or subcutaneous tophus. Gout was defined by synovial fluid or tophus aspirate microscopy by certified examiners in all patients. The sample was randomly divided into a model development (2/3) and test sample (1/3). Univariate and multivariate association between clinical features and MSU-defined gout was determined using logistic regression modelling. Shrinkage of regression weights was performed to prevent over-fitting of the final model. Latent class analysis was conducted to identify patterns of joint involvement. In total, 983 patients were included. Gout was present in 509 (52%). In the development sample (n=653), these features were selected for the final model (multivariate OR) joint erythema (2.13), difficulty walking (7.34), time to maximal pain < 24 hours (1.32), resolution by 2 weeks (3.58), tophus (7.29), MTP1 ever involved (2.30), location of currently tender joints: Other foot/ankle (2.28), MTP1 (2.82), serum urate level > 6 mg/dl (0.36 mmol/l) (3.35), ultrasound double contour sign (7.23), Xray erosion or cyst (2.49). The final model performed adequately in the test set with no evidence of misfit, high discrimination and predictive ability. MTP1 involvement was the most common joint pattern (39.4%) in gout cases. Ten key discriminating features have been identified for further evaluation for new gout classification criteria. Ultrasound findings and degree of uricemia add discriminating value, and will significantly contribute to more accurate classification criteria.