A Clinical Prediction Rule for Lymphoma Development in Primary Sjogren's Syndrome
A Clinical Prediction Rule for Lymphoma Development in Primary Sjogren's Syndrome
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DOI：
10.3899/jrheum.110754
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发表时间：
2012-04-01
影响因子：
3.9
通讯作者：
Bombardieri, Stefano
中科院分区：
文献类型：
--
作者：
Baldini, Chiara;Pepe, Pasquale;Bombardieri, Stefano
Objective.目的：结合临床和血清学指标，建立并验证原发性干燥综合征（pSS）向B细胞非霍奇金淋巴瘤（B cell non-Hodgkin's lymphoma，NHL）进展的实用预测规则。我们回顾了563例pSS患者的病例记录，收集了他们的人口统计学、临床和免疫学特征。进行多变量逻辑回归分析，以确定淋巴瘤发展的独立风险因素，并建立一个倾向评分，区分B细胞NHL风险患者和无风险患者。该模型是内部验证的Rescovery程序。在563例pSS患者中，有387例符合美国欧洲共识组标准（12例患有B细胞NHL，375例没有B细胞NHL）。唾液腺增大（p = 0.001）、低C3（p = 0.035）和/或C4水平（p = 0.021）和疾病持续时间（p = 0.001）被确定为pSS患者B细胞NHL的独立风险因素。倾向评分的最佳阈值确定为Y = 4.26，这使我们能够以78%的灵敏度和95%的特异性识别发生B细胞NHL的患者。留一法交叉验证的预测误差为6%，自举法的中位敏感性和特异性分别为71%和95%。我们建立了一个“床旁”预测模型，用于识别有B细胞NHL风险的pSS患者，该模型显示出良好的区分能力和良好的内部和外部重现性。（2012年2月15日首次发布; J Rheumol 2012;39：804-8; doi：10.3899/jrheum.110754）
Objective. To develop and validate a practical prediction rule for the progression from primary Sjogren's syndrome (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 lymphoma development 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. (First Release Feb 15 2012; J Rheumatol 2012;39:804-8; doi:10.3899/jrheum.110754)