Psychology Department, Macquarie University, North Ryde, NSW, Australia.
Aliment Pharmacol Ther. 2014 Feb;39(4):426-37. doi: 10.1111/apt.12608. Epub 2014 Jan 6.
The development of a reliable biomarker for irritable bowel syndrome (IBS) remains one of the major aims of research in functional gastrointestinal disorders (FGIDs) and is complicated by the absence of a perfect reference standard. Previous efforts based on genetic and immune markers have showed promise, but have not been robust.
To evaluate an extensive panel of gene expression and serology markers combined with psychological measures in differentiating IBS from health and between subtypes of IBS.
Of subjects eligible for analysis (N = 244), 168 met criteria for IBS (60 IBS-C, 57 IBS-D and 51 mixed), while 76 were free of any FGID. A total of 34 markers were selected based on pathways implicated in pathophysiology of IBS or whole human genome screening. Psychological measures were recorded that covered anxiety, depression and somatisation. Models differentiating disease and health were based on unconditional logistic regression and performance assessed through area under the receiver-operator characteristic curve (AUC), sensitivity and specificity.
The performance of a combination of 34 markers was good in differentiating IBS from health (AUC = 0.81) and was improved considerably with the addition of four psychological markers (combined AUC = 0.93). Of the 34 markers considered, discrimination was derived largely from a small subset. Good discrimination was also obtained between IBS subtypes with the best being observed for IBS-C vs. IBS-D (AUC = 0.92); however, psychological variables provided almost no incremental discrimination subtypes over biological markers (combined AUC = 0.94).
A combination of gene expression and serological markers in combination with psychological measures shows exciting progress towards a diagnostic test for IBS compared with healthy subjects, and to discriminate IBS-C from IBS-D.
对于肠易激综合征（IBS）来说，开发一种可靠的生物标志物仍然是功能性胃肠疾病（FGIDs）研究的主要目标之一，而缺乏完美的参考标准使得这一目标变得更加复杂。以前基于遗传和免疫标志物的研究虽然显示出了一定的前景，但并不稳健。
评估广泛的基因表达和血清学标志物组合与心理测量在区分 IBS 与健康人群以及 IBS 各亚型中的作用。
在符合分析条件的受试者中（N=244），168 名符合 IBS 标准（60 名 IBS-C、57 名 IBS-D 和 51 名混合型），而 76 名无任何 FGID。基于与 IBS 病理生理学相关的途径或全人类基因组筛查，选择了总共 34 个标记物。记录了涵盖焦虑、抑郁和躯体化的心理测量。用于区分疾病和健康的模型基于无条件逻辑回归，通过接收者操作特征曲线（ROC）下的面积（AUC）、敏感性和特异性来评估性能。
34 个标志物组合在区分 IBS 与健康人群方面表现良好（AUC=0.81），并且通过添加四个心理标志物，性能得到了显著提高（综合 AUC=0.93）。在考虑的 34 个标志物中，大部分区分主要来自一小部分标志物。各 IBS 亚型之间的区分也很好，其中 IBS-C 与 IBS-D 之间的区分最好（AUC=0.92）；然而，心理变量对区分各 IBS 亚型的作用几乎没有超过生物标志物（综合 AUC=0.94）。
与健康人群相比，基因表达和血清学标志物与心理测量的组合在 IBS 诊断测试方面取得了令人兴奋的进展，并且可以区分 IBS-C 和 IBS-D。
