Abstract：
OBJECTIVE: Systemic lupus erythematous (SLE) is a heterogenous disease characterised by a large panel of autoantibodies and a wide spectrum of clinical signs and symptoms that engender different outcomes. We aimed to identify distinct, homogeneous SLE patients\' phenotypes.
METHODS: This retrospective study enrolled SLE patients meeting the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, enrolled in the French multicentre \"APS (antiphospholipid syndrome) and SLE\" Registry. Based on 29 variables selected to cover a broad range of clinical and laboratory (excluding autoantibodies) SLE manifestations, unsupervised multiple correspondence analysis followed by hierarchical ascendent-clustering analysis assigned different phenotypes.
RESULTS: We included 440 patients, mostly women (94.3%). Median age at SLE diagnosis was 24 (IQR 19-32) years. Cluster analysis yielded three distinct subgroups based on cumulative clinical manifestations, not autoantibody pattern. Cluster 1 (n=91) comprised mostly Caucasian patients, with APS-associated clinical and biological manifestations, e.g., livedo, seizure, thrombocytopaenia and haemolytic anaemia. Cluster 2 (n=221), the largest, included patients with mild clinical manifestations, mainly articular, more frequently associated with Sjögren\'s syndrome and with less frequent autoantibody-positivity. Cluster 3 (n=128) consisted of patients with the largest panel of SLE-specific clinical manifestations (cutaneous, articular, proliferative nephritis, pleural, cardiac and haematological), the most frequent autoantibody-positivity, low complement levels, and more often of Asian and sub-Saharan African origin.
CONCLUSIONS: This unsupervised clustering method distinguished three distinct SLE patient subgroups, highlighting SLE heterogeneity.
METHODS: This retrospective study enrolled SLE patients meeting the Systemic Lupus International Collaborating Clinics (SLICC) classification criteria, enrolled in the French multicentre \"APS (antiphospholipid syndrome) and SLE\" Registry. Based on 29 variables selected to cover a broad range of clinical and laboratory (excluding autoantibodies) SLE manifestations, unsupervised multiple correspondence analysis followed by hierarchical ascendent-clustering analysis assigned different phenotypes.
RESULTS: We included 440 patients, mostly women (94.3%). Median age at SLE diagnosis was 24 (IQR 19-32) years. Cluster analysis yielded three distinct subgroups based on cumulative clinical manifestations, not autoantibody pattern. Cluster 1 (n=91) comprised mostly Caucasian patients, with APS-associated clinical and biological manifestations, e.g., livedo, seizure, thrombocytopaenia and haemolytic anaemia. Cluster 2 (n=221), the largest, included patients with mild clinical manifestations, mainly articular, more frequently associated with Sjögren\'s syndrome and with less frequent autoantibody-positivity. Cluster 3 (n=128) consisted of patients with the largest panel of SLE-specific clinical manifestations (cutaneous, articular, proliferative nephritis, pleural, cardiac and haematological), the most frequent autoantibody-positivity, low complement levels, and more often of Asian and sub-Saharan African origin.
CONCLUSIONS: This unsupervised clustering method distinguished three distinct SLE patient subgroups, highlighting SLE heterogeneity.
摘要：
目的：系统性红斑狼疮（SLE）是一种异质性疾病，其特征是大量自身抗体和广泛的临床体征和症状，导致不同的结局。我们的目标是识别不同的，同质SLE患者表型。
方法：这项回顾性研究招募了符合系统性狼疮国际合作诊所（SLICC）分类标准的SLE患者，参加法国多中心“APS(抗磷脂综合征)和SLE注册表”。根据29个变量选择涵盖广泛的临床和实验室（不包括自身抗体）SLE表现，无监督的多重对应分析，然后是分配不同表型的分层上升聚类分析。
结果：我们纳入了440例患者，主要是女性（94.3%）。诊断为SLE的中位年龄为24（IQR19-32）岁。聚类分析根据累积的临床表现产生了三个不同的亚组，不是自身抗体模式。第1组(n=91)主要包括白种人患者，与APS相关的临床和生物学表现，例如，Livedo,癫痫发作,血小板减少症和溶血性贫血。集群2（n=221），最大的,包括临床表现轻微的患者，主要是关节，更常与干燥综合征相关，自身抗体阳性频率更低。第3组（n=128）包括SLE特异性临床表现最大组的患者（皮肤，关节，增生性肾炎,胸膜,心脏和血液学），最常见的自身抗体阳性，低补体水平,更多来自亚洲和撒哈拉以南非洲。
结论：这种无监督聚类方法区分了三个不同的SLE患者亚组，突出SLE异质性。
方法：这项回顾性研究招募了符合系统性狼疮国际合作诊所（SLICC）分类标准的SLE患者，参加法国多中心“APS(抗磷脂综合征)和SLE
结果：我们纳入了440例患者，主要是女性（94.3%）。诊断为SLE的中位年龄为24（IQR19-32）岁。聚类分析根据累积的临床表现产生了三个不同的亚组，不是自身抗体模式。第1组(n=91)主要包括白种人患者，与APS相关的临床和生物学表现，例如，Livedo,癫痫发作,血小板减少症和溶血性贫血。集群2（n=221），最大的,包括临床表现轻微的患者，主要是关节，更常与干燥综合征相关，自身抗体阳性频率更低。第3组（n=128）包括SLE特异性临床表现最大组的患者（皮肤，关节，增生性肾炎,胸膜,心脏和血液学），最常见的自身抗体阳性，低补体水平,更多来自亚洲和撒哈拉以南非洲。
结论：这种无监督聚类方法区分了三个不同的SLE患者亚组，突出SLE异质性。
