Miller Larry E, Ibarra Alvin, Ouwehand Arthur C
Miller Scientific Consulting, Asheville, NC, USA.
Global Health and Nutrition Sciences, DuPont Nutrition & Health, Kantvik, Finland.
Clin Med Insights Gastroenterol. 2017 Aug 31;11:1179552217729343. doi: 10.1177/1179552217729343. eCollection 2017.
Availability of normative patient outcome data may assist in designing experiments and estimating sample sizes. The purpose of this review was to determine normative ranges for colonic transit time (CTT), Patient Assessment of Constipation-Symptoms (PAC-SYM), and Patient Assessment of Constipation-Quality of Life (PAC-QOL) in adults diagnosed with functional constipation per Rome III guidelines. Pooled estimates were derived from random-effects meta-analysis. Meta-regression was used to explore sources of heterogeneity among studies. A total of 24 studies (3786 patients) were included in the review. In 10 studies with 1119 patients, pooled CTT was 58 hours (95% confidence interval [CI]: 50-65 hours). Publication bias was not evident (Egger = .51); heterogeneity was high ( = 92%, < .001). In meta-regression, geographical location explained 57% of the between-study variance, with CTT significantly longer in studies conducted in Europe (71 hours) compared with Asia (49 hours) or the Americas (44 hours). In 9 studies with 2061 patients, pooled PAC-SYM was 1.70 (95% CI: 1.58-1.83). Publication bias was not evident (Egger = .44). Heterogeneity was high ( = 90%, < .001); however, no study or patient factor influenced PAC-SYM in meta-regression. In 12 studies with 1805 patients, pooled PAC-QOL was 1.97 (95% CI: 1.70-2.24). Publication bias was not evident (Egger = .28); heterogeneity was high ( = 98%, < .001). In meta-regression, age explained 52% of the between-study variance, with older age associated with lower PAC-QOL scores. Overall, in adults diagnosed with functional constipation per Rome III criteria, significant heterogeneity in CTT, PAC-SYM, and PAC-QOL exists among studies. Variability among studies may be explained by geography and patient factors.
规范性患者预后数据的可用性可能有助于设计实验和估计样本量。本综述的目的是确定根据罗马III标准诊断为功能性便秘的成年人的结肠传输时间（CTT）、便秘症状患者评估（PAC-SYM）和便秘生活质量患者评估（PAC-QOL）的正常范围。汇总估计值来自随机效应荟萃分析。采用Meta回归分析探讨研究间异质性的来源。本综述共纳入24项研究（3786例患者）。在10项研究中的1119例患者中，汇总CTT为58小时（95%置信区间[CI]：50-65小时）。未发现明显的发表偏倚（Egger检验=0.51）；异质性较高（I²=92%，P<0.001）。在Meta回归分析中，地理位置解释了研究间差异的57%，与亚洲（49小时）或美洲（44小时）的研究相比，欧洲的研究CTT显著更长（71小时）。在9项研究中的2061例患者中，汇总PAC-SYM为1.70（95%CI：1.58-1.83）。未发现明显的发表偏倚（Egger检验=0.44）。异质性较高（I²=90%，P<0.001）；然而，在Meta回归分析中，没有研究或患者因素影响PAC-SYM。在12项研究中的1805例患者中，汇总PAC-QOL为1.97（95%CI：1.70-2.24）。未发现明显的发表偏倚（Egger检验=0.28）；异质性较高（I²=98%，P<0.001）。在Meta回归分析中，年龄解释了研究间差异的52%，年龄越大，PAC-QOL得分越低。总体而言，在根据罗马III标准诊断为功能性便秘的成年人中，研究间CTT、PAC-SYM和PAC-QOL存在显著异质性。研究间的变异性可能由地理位置和患者因素解释。
