慢性便秘的新分类方法
  • 纳入661名慢性便秘患者,其中365名诊断为便秘型肠易激综合征(IBS-C),296名诊断为功能性便秘(FC),通过机器学习研究目前的诊断分类是否合理;
  • IBS-C和FC仅在腹痛这一个临床维度上存在区别,因此二者的差异并非在综合征层面上,而是在单一症状上;
  • 基于一个含18个特征的网络,可将患者分为两个聚类,主要差异体现在疾病影响和生活质量方面,包括饮食习惯、心情、内脏感觉等;
  • 这种新的分类方法,或将影响慢性便秘的临床诊疗。
主编推荐语
mildbreeze
慢性便秘目前被划分为两种主要的综合征——便秘型肠易激综合征(IBS-C)和功能性便秘(FC),这主要是基于这两种综合征有不同的临床和病生理特征,但也有研究认为这两种综合征并不是完全不同的,而是属于同一种谱系疾病。American Journal of Gastroenterology近期发表的一项研究表明,IBS-C和FC仅在腹痛这一个症状上存在区别,因此二者更像是属于同一个谱系疾病,而不是两种综合征。该研究还提出了一种新的对慢性便秘的分类模型,或对临床诊疗带来新思路。
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Constipation Predominant Irritable Bowel Syndrome and Functional Constipation Are Not Discrete Disorders: A Machine Learning Approach

便秘为主的肠易激综合征和功能性便秘并非不同的疾病类型: 一种机器学习方法

10.14309/ajg.0000000000000816

2020-08-31, Article

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Introduction: Chronic constipation is classified into 2 main syndromes, irritable bowel syndrome with constipation (IBS-C) and functional constipation (FC), on the assumption that they differ along multiple clinical characteristics and are plausibly of distinct pathophysiology. Our aim was to test this assumption by applying machine learning to a large prospective cohort of comprehensively phenotyped patients with constipation.
Methods: Demographics, validated symptom and quality of life questionnaires, clinical examination findings, stool transit, and diagnosis were collected in 768 patients with chronic constipation from a tertiary center. We used machine learning to compare the accuracy of diagnostic models for IBS-C and FC based on single differentiating features such as abdominal pain (a "unisymptomatic" model) vs multiple features encompassing a range of symptoms, examination findings and investigations (a "syndromic" model) to assess the grounds for the syndromic segregation of IBS-C and FC in a statistically formalized way.
Results: Unisymptomatic models of abdominal pain distinguished between IBS-C and FC cohorts near perfectly (area under the curve 0.97). Syndromic models did not significantly increase diagnostic accuracy (P > 0.15). Furthermore, syndromic models from which abdominal pain was omitted performed at chance-level (area under the curve 0.56). Statistical clustering of clinical characteristics showed no structure relatable to diagnosis, but a syndromic segregation of 18 features differentiating patients by impact of constipation on daily life.
Discussion: IBS-C and FC differ only about the presence of abdominal pain, arguably a self-fulfilling difference given that abdominal pain inherently distinguishes the 2 in current diagnostic criteria. This suggests that they are not distinct syndromes but a single syndrome varying along one clinical dimension. An alternative syndromic segregation is identified, which needs evaluation in community-based cohorts. These results have implications for patient recruitment into clinical trials, future disease classifications, and management guidelines.

First Authors:
James K Ruffle

Correspondence Authors:
Yan Yiannakou

All Authors:
James K Ruffle,Linda Tinkler,Christopher Emmett,Alexander C Ford,Parashkev Nachev,Qasim Aziz,Adam D Farmer,Yan Yiannakou

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