ارزيابي شدت بيماري آرتريت روماتوئيد بر اساس ميزان سديمانتاسيون خون و مفاصل حساس با استفاده از مدل طولي

Evaluation of the Severity of Rheumatoid Arthritis based on Blood Sedimentation Rate and Sensitive Joints using a Longitudinal Model

شدت بيماري آرتريت روماتوييد متغير پنهاني است كه مي بايست توسط ابزاري مناسب اندازه گيري شود. اين متغير نقش مهمي در بررسي وضعيت بيماري افراد در يك مقطع زماني و در طول زمان ايفا مي نمايد. ابزارDAS28 يكي از ابزارهاي رايج و مناسب در اندازه گيري شدت بيماري آرتريت روماتوييد است. دو مولفه اصلي اين ابزار، ارگان عمومي (ميزان سديمانتاسيون خون) و ارگان مفاصل (تعداد مفاصل حساس) بيماران آرتريت روماتوييد است كه از مقياس رتبه اي برخوردار مي باشند. هدف اين پژوهش ارايه يك مدل با اثرات تصادفي حاشيه اي شده توام جهت بررسي عوامل موثر بر اين مولفه ها است. از اين رويكرد جهت تحليل هم زمان متغيرهاي كه داراي همبستگي بين مشاهدات است، استفاده مي شود. ﻣﻮاد و روش ﻫﺎ: داده ﻫﺎي ﻣﻮرد اﺳﺘﻔﺎده در اﯾﻦ ﭘﮋوﻫﺶ اﻃﻼﻋﺎت ﭘﺮوﻧﺪه 107 ﺑﯿﻤﺎر ﻣﺒﺘﻼ ﺑﻪ آرﺗﺮﯾﺖ روﻣﺎﺗﻮﺋﯿﺪ اﺳﺖ ﮐﻪ در ﺑﺎزه زﻣﺎﻧﯽ ﺳﺎل ﻫﺎي 1395 ﺗﺎ 1397 ﺑﻪ ﺑﯿﻤﺎرﺳﺘﺎن ﺷﺮﯾﻌﺘﯽ ﺗﻬﺮان ﻣﺮاﺟﻌﻪ ﮐﺮده اﻧﺪ. ﻣﺘﻐﯿﺮﻫﺎي ﭘﺎﺳﺦ، ﻣﯿﺰان ﺳﺪﯾﻤﺎﻧﺘﺎﺳﯿﻮن ﺧﻮن و ﻣﻔﺎﺻﻞ ﺣﺴﺎس ﺑﯿﻤﺎران ﺑﻮده ﮐﻪ ﺑﻪ ﺻﻮرت رﺗﺒﻪ اي، دﺳﺘﻪ ﺑﻨﺪي ﺷﺪه اﻧﺪ. دو ﻣﺪل، اﺛﺮات ﺗﺼﺎدﻓﯽ ﺣﺎﺷﯿﻪ اي ﺷﺪه ﺗﮏ ﻣﺘﻐﯿﺮه و ﻣﺪل اﺛﺮات ﺗﺼﺎدﻓﯽ ﺣﺎﺷﯿﻪ اي ﺷ ﺪه ﺗﻮأم ﺑﺮاي ﻣﺪل ﺑﻨﺪي اﺳﺘﻔﺎده و اﻧﺘﺨﺎب ﺑﻬﺘﺮﯾﻦ ﻣﺪل ﺑﺮ اﺳﺎس ﺣﺪاﻗﻞ ﺑﻮدن ﻣﻘﺪار آﮐﺎﺋﯿﮏ اﻧﺠﺎم ﺷﺪ. ﺑﻪ ﻣﻨﻈﻮر ﺗﺠﺰﯾﻪ و ﺗﺤﻠﯿﻞ داده ﻫﺎ از ﻧﺮم اﻓﺰار SAS ﻧﺴﺨﻪ 9/4 اﺳﺘﻔﺎده و ﻧﺘﺎﯾﺞ در ﺳﻄﺢ ﻣﻌﻨﯽ داري 0/05 ﮔﺰارش ﮔﺮدﯾﺪ. ﯾﺎﻓﺘﻪ ﻫﺎي ﭘﮋوﻫﺶ: در ﻣﺪل اﺛﺮات ﺗﺼﺎدﻓﯽ ﺣﺎﺷﯿﻪ اي ﺷﺪه ﺗﻮ أم، اﺛﺮ زﻣﺎن روي ﻣﺘﻐﯿﺮ ﻣﯿﺰان ﺳﺪﯾﻤﺎﻧﺘﺎﺳﯿﻮن ﺧﻮن)1/1-27/93:CI 95 درﺻﺪ ، 1/56=OR( ﻣﻌﻨﯽ دار ﺑﻮد. ﻫﻢ ﭼﻨﯿﻦ اﺛﺮ زﻣﺎن)1/55-2/21:CI 95 در ﺻ ﺪ، 1/85=OR(، ﻣ ﺼﺮف ﺳﯿﮕﺎر )0/12-0/82:CI 95 در ﺻﺪ ، 0/31=OR(، ﺳﻄﺢ وﯾﺘﺎﻣﯿﻦ د ﺧﻮن )1/00-1/02:CI 95 در ﺻﺪ ، 1/01=OR( روي ﻣﺘﻐﯿﺮ ﻣﻔﺎ ﺻﻞ ﺣ ﺴﺎس ﺑﯿﻤﺎر ارﺗﺒﺎط آﻣﺎري ﻣﻌﻨﯽ داري دا ﺷﺖ. ﻓﻮا ﺻﻞ اﻃﻤﯿﻨﺎن، ﺧﻄﺎي ﻣﻌﯿﺎر و ﻫﻢ ﭼﻨﯿﻦ ﻣﻘﺪار آﮐﺎﺋﯿﮏ در ﻣﺪل اﺛﺮات ﺗﺼﺎدﻓﯽ ﺣﺎﺷﯿﻪ اي ﺷﺪه ﺗﻮأم ﮐﻤﺘﺮ از ﻣﺪل ﺗﮏ ﻣﺘﻐﯿﺮه ﺑﻮد. نتايج نشان داد كه مدل اثرات تصادفي حاشيه اي شده توام مي تواند ميانگين حاشيه اي را در كل جامعه بيماران آرتريت روماتوييد و نيز همبستگي بين مشاهدات را لحاظ نمايد. هم چنين نتيجه اين مطالعه نشان داد كه عوامل موثر بر شدت بيماري در نمونه مورد مطالعه با استفاده از مدل JMRE، عبارت از زمان، مصرف سيگار و سطح ويتامين د خون است.

Disease severity of Rheumatoid Arthritis is a latent concept which should be observed using a measurement tool. This variable plays a significant role in assessing disease status both cross-sectionally and longitudinally. The DAS28 scale is a valid instrument for assessing rheumatoid arthritis severity. This scale consists of two components, namely, the general system (blood sedimentation rate) and joint system (sensitive joints) as two correlated ordinal responses. The purpose of this study was to determine the process and affecting factors of the disease. This study aimed to present a marginalized random-effect model accompanied by the factors influencing these components. This method is used to assess the variables with associations simultaneously. Materials & Methods This study utilized the information of 107 patients with rheumatoid arthritis who referred to Shariati Hospital, Tehran, Iran, during 2016-18. The response variables were the general system and joint system of patients that were classified by rank. A marginalized random-effects model and a joint marginalized random-effects model were used and the best model was selected based on the minimum amount of AIC. Data were analyzed using SAS software (version 9.4). A p-value less than 0.05 was considered statistically significant. Ethics code: IR.USWR.REC.1397.045 Findings In the joint marginalized random-effects model, the effect of time was significant on the rate of blood sedimentation (OR=1.56, 95% CI: 1.27-1.93). Moreover, time (OR=1.85, 95% CI: 1.55-2.21), smoking (OR=0.31, 95% CI: 0.12-0.82), and level of vitamin D (OR=1.0, 95% CI: 1.00-1.02) had a significant effect on sensitive joints. Confidence intervals, standard error, and amount of the AIC in the joint marginalized random-effects model were less than the univariable model. Discussions & Conclusions The results showed that the joint marginalized random-effect model could implement the mean of the marginal in the population as well as the correlation between the observations. Moreover, it was shown that the factors influencing the severity of the disease among the patients under study using the joint marginalized random-effects model included time, smoking, and vitamin D levels.