Bonavita Vincenzo, De Simone Roberto
Headache Centre Department of Neurological Sciences, University of Naples Federico II, Via Pansini 5, 80131 Naples, Italy.
Neurol Sci. 2008 May;29 Suppl 1:S99-102. doi: 10.1007/s10072-008-0898-1.
Clinical complexity encompasses multiple levels, including all the disorders and conditions experienced by a person along cross-sectional and longitudinal contexts, the diversity of severity levels and courses of clinical conditions, but also the plurality of values of people experiencing health problems and seeking help for them. The term comorbidity refers to the association of two distinct diseases in the same individual at a rate higher than expected by chance. Looking systematically to comorbidity represents the main road to approach patients' clinical complexity. Once epidemiologically established through population or community surveys, the study of the comorbidity direction and of the chronological patterns of associated clinical entities may offer relevant information from both a clinical and a scientific point of view. Comorbidity profiles of migraine and tension-type headache offer a paradigmatic example to appraise and highlight headache patient clinical complexity, allowing the conversion of diagnosis from a validated cluster of symptoms to a person-centred clinical diagnosis.
临床复杂性涵盖多个层面，包括一个人在横断面和纵向背景下所经历的所有疾病和状况、临床病症严重程度和病程的多样性，以及存在健康问题并为此寻求帮助的人群价值观的多元性。“共病”一词指的是两种不同疾病在同一个体中同时出现的几率高于偶然预期。系统地研究共病是了解患者临床复杂性的主要途径。一旦通过人群或社区调查在流行病学上得以确定，对共病方向以及相关临床实体的时间模式的研究可能会从临床和科学角度提供相关信息。偏头痛和紧张型头痛的共病情况为评估和突出头痛患者的临床复杂性提供了一个典型例子，使得诊断能够从经过验证的症状群转变为以患者为中心的临床诊断。
