Koloski N A, Jones M, Young M, Talley N J
Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
Aliment Pharmacol Ther. 2015 May;41(9):856-66. doi: 10.1111/apt.13149. Epub 2015 Mar 4.
While the Rome III classification recognises functional constipation (FC) and constipation predominant IBS (IBS-C) as distinct disorders, recent evidence has suggested that these disorders are difficult to separate in clinical practice.
To identify whether clinical and lifestyle factors differentiate Rome III-defined IBS-C from FC based on gastrointestinal symptoms and lifestyle characteristics.
3260 people randomly selected from the Australian population returned a postal survey. FC and IBS-C were defined according to Rome III. The first model used logistic regression to differentiate IBS-C from FC based on lifestyle, quality-of-life and psychological characteristics. The second approach was data-driven employing latent class analysis (LCA) to identify naturally occurring clusters in the data considering all symptoms involved in the Rome III criteria for IBS-C and FC.
We found n = 206 (6.5%; 95% CI 5.7-7.4%) people met strict Rome III FC whereas n = 109 (3.5%; 95% CI 2.8-4.1%) met strict Rome III IBS-C. The case-control approach indicated that FC patients reported an older age at onset of constipation, were less likely to exercise, had higher mental QoL and less health care seeking than IBS-C. LCA yielded one latent class that was predominantly (75%) FC, while the other class was approximately half IBS-C and half FC. The FC-dominated latent class had clearly lower levels of symptoms used to classify IBS (pain-related symptoms) and was more likely to be male (P = 0.046) but was otherwise similar in distribution of lifestyle factors to the mixed class.
The latent class analysis approach suggests a differentiation based more on symptom severity rather than the Rome III view.
虽然罗马Ⅲ分类法将功能性便秘（FC）和以便秘为主型肠易激综合征（IBS-C）视为不同的疾病，但最近的证据表明，在临床实践中很难区分这些疾病。
根据胃肠道症状和生活方式特征，确定临床和生活方式因素是否能区分罗马Ⅲ定义的IBS-C和FC。
从澳大利亚人群中随机抽取3260人进行邮寄调查。FC和IBS-C根据罗马Ⅲ标准定义。第一个模型使用逻辑回归，根据生活方式、生活质量和心理特征区分IBS-C和FC。第二种方法是数据驱动的，采用潜在类别分析（LCA），考虑罗马Ⅲ标准中IBS-C和FC所涉及的所有症状，识别数据中自然出现的聚类。
我们发现n = 206人（6.5%；95%可信区间5.7-7.4%）符合严格的罗马Ⅲ FC标准，而n = 109人（3.5%；95%可信区间2.8-4.1%）符合严格的罗马Ⅲ IBS-C标准。病例对照研究表明，与IBS-C患者相比，FC患者便秘发病年龄较大，运动较少，心理生活质量较高，寻求医疗保健的可能性较小。LCA产生了一个主要为FC（75%）的潜在类别，而另一个类别约一半为IBS-C，一半为FC。以FC为主的潜在类别用于分类IBS的症状（疼痛相关症状）水平明显较低，男性比例更高（P = 0.046），但在生活方式因素分布上与混合类别相似。
潜在类别分析方法表明，区分更多基于症状严重程度，而非罗马Ⅲ的观点。
