不同年龄段类风湿关节炎贫血患者免疫、炎症、脂代谢的数据挖掘研究

Data mining study on immune,inflammation and lipid metabolism in patients with rheumatoid arthritis accompanying anemia of different ages

目的:运用数据挖掘方法分析不同年龄段类风湿关节炎(RA)贫血患者红细胞参数的变化,并探究其与免疫、炎症、脂代谢指标的相关性及关联规则。方法:收集并整理2012年6月至2018年1月在安徽省中医院风湿科确诊的RA贫血住院患者的病历资料,共计2 606例患者符合纳入标准,按照我国年龄划分标准,以年龄≥60岁划分为老年人。将患者分为实验组(≥60岁)和对照组(<60岁),对患者红细胞参数、炎症、免疫、脂代谢指标进行比较,相关性分析及关联规则的挖掘。结果:①共计2 606例RA贫血患者符合标准,其中对照组患者1 640例,实验组966例,患者住院治疗天数、合并高脂血症方面差异无统计学意义(P>0.05)。②对照组、实验组RA贫血患者均以轻度、中度贫血为主,两组轻、中度贫血分别占比98.97%、98.05%;对照组、实验组贫血类型都以正细胞正色素性为主,分别占比70.61%、81.22%。③对照组患者的RBC、MCV、MCH、MCHC、Anti-CCP、IgG、IgM指标水平均高于实验组,差异有统计学意义(P<0.05或P<0.01);而实验组患者WBC、Hs-CRP、RF、IgA、TC、HDL-C、LDL-C水平均高于对照组,差异有统计学意义(P<0.05或P<0.01)。④相关性分析发现:两组患者RBC、Hb的变化与免疫炎症指标、脂代谢指标存在明显相关性;其中两组的Hb均与Hs-CRP、IgA、IgG、IgM呈负相关,表明随着两组hs-CRP、IgA、IgG、IgM值的升高,患者的Hb值将下降。⑤对照组患者RBC的下降与Anti-CCP、IgA、RF、CRP的升高具有强关联关系;实验组患者RBC的下降与Anti-CCP、Hs-CRP、RF、IgM的升高具有强关联关系。结论:中青年和老年RA贫血患者在贫血程度、贫血类型、免疫炎症反应、脂代谢方面存在一定差异。相同的是两组患者随着免疫炎症反应指标的升高,患者的贫血程度将加重。不同的是老年RA贫血患者在炎症反应、RF升高、脂代谢紊乱情况显著高于中青年患者,提示老年患者疾病活动性更高,合并脂质代谢疾病的风险更高。

Objective:Data mining was used to analyze the changes of erythrocyte parameters in patients with rheumatoid arthritis(RA) anemia at different ages,and to explore the correlation and association rules between erythrocyte parameters and immunity,inflammation and lipid metabolism.Methods:The medical records of patients with RA anemia diagnosed in rheumatology department of Anhui Provincial Hospital of Traditional Chinese Medicine from June 2012 to January 2018 were collected and collated.A total of 2 606 patients met the inclusion criteria.According to China′s age classification criteria,the elderly were classified according to their age(≥60 years old).In this study,erythrocyte parameters,inflammation,immunity and lipid metabolism were compared,correlation analysis and association rules mining were conducted.Results:①A total of 2 606 patients with RA anemia met the criteria.There were 1 640 patients in the control group and 966 patients in the experimental group.There was no significant difference in hospitalization days and hyperlipidemia between the two groups(P>0.05).②The patients with RA anemia in the control group and the experimental group were mainly mild and moderate anemia.The proportion of mild and moderate anemia in the two groups was 98.97% and 98.05% respectively.Normocytic anemia was the main type of anemia in control group and experimental group,accounting for 70.61% and 81.22% respectively.③The levels of RBC,MCV,MCH,MCHC,Anti-CCP,IgG and IgM in the control group were higher than those in the experimental group(P<0.05 or P<0.01).The levels of WBC,Hs-CRP,RF,IgA,TC,HDL-C and LDL-C in the experimental group were higher than those in the control group(P<0.05 or P<0.01).④The correlation analysis showed that the changes of RBC and Hb in the two groups were significantly correlated with the indexes of immune inflammation and lipid metabolism.Among them,the HB values of both groups were negatively correlated with Hs-CRP,IgA,IgG and IgM,indicating that with the increase of Hs-CRP,IgA,IgG and IgM values in both groups,the Hb values of patients would decrease.⑤The decrease of RBC in control group was strongly correlated with the increase of Anti-CCP,IgA,RF and CRP.The decrease of RBC in the experimental group was strongly correlated with the increase of Anti-CCP,Hs-CRP,RF and IgM.Conclusion:There are some differences in the degree of anemia,type of anemia,immune inflammation reaction and lipid metabolism between young and old patients with RA accompanied by anemia.Similarly,the degree of anemia will increase with the increase of immune inflammation in both groups.The difference is that elderly patients with RA accompanied by anemia are significantly higher in inflammatory response,RF elevation and lipid metabolism disorders than young and middle-aged patients.This result suggests that elderly patients have higher disease activity and higher risk of complicating with lipid metabolism disorders.