Park Sa-Yoon, Bae Hyojin, Jeong Ha-Yeong, Lee Ju Yup, Kwon Young-Kyu, Kim Chang-Eop
Department of Physiology, College of Korean Medicine, Gachon University, Seongnam 13120, Republic of Korea.
Biomedical Research Institute, Seoul National University Hospital, Seoul 03080, Republic of Korea.
J Clin Med. 2024 May 10;13(10):2821. doi: 10.3390/jcm13102821.
Given the limited success in treating functional gastrointestinal disorders (FGIDs) through conventional methods, there is a pressing need for tailored treatments that account for the heterogeneity and biopsychosocial factors associated with FGIDs. Here, we considered the potential of novel subtypes of FGIDs based on biopsychosocial information. : We collected data from 198 FGID patients utilizing an integrative approach that included the traditional Korean medicine diagnosis questionnaire for digestive symptoms (KM), as well as the 36-item Short Form Health Survey (SF-36), alongside the conventional Rome-criteria-based Korean Bowel Disease Questionnaire (K-BDQ). Multivariate analyses were conducted to assess whether KM or SF-36 provided additional information beyond the K-BDQ and its statistical relevance to symptom severity. Questions related to symptom severity were selected using an extremely randomized trees (ERT) regressor to develop an integrative questionnaire. For the identification of novel subtypes, Uniform Manifold Approximation and Projection and spectral clustering were used for nonlinear dimensionality reduction and clustering, respectively. The validity of the clusters was assessed using certain metrics, such as trustworthiness, silhouette coefficient, and accordance rate. An ERT classifier was employed to further validate the clustered result. : The multivariate analyses revealed that SF-36 and KM supplemented the psychosocial aspects lacking in K-BDQ. Through the application of nonlinear clustering using the integrative questionnaire data, four subtypes of FGID were identified: mild, severe, mind-symptom predominance, and body-symptom predominance. : The identification of these subtypes offers a framework for personalized treatment strategies, thus potentially enhancing therapeutic outcomes by tailoring interventions to the unique biopsychosocial profiles of FGID patients.
鉴于通过传统方法治疗功能性胃肠疾病（FGIDs）的成效有限，迫切需要针对FGIDs相关的异质性和生物心理社会因素进行量身定制的治疗。在此，我们基于生物心理社会信息考虑了FGIDs新亚型的潜力。我们采用综合方法收集了198例FGID患者的数据，该方法包括用于消化症状的传统韩医诊断问卷（KM）、36项简短健康调查（SF - 36）以及基于传统罗马标准的韩国肠道疾病问卷（K - BDQ）。进行多变量分析以评估KM或SF - 36是否能提供超出K - BDQ的额外信息及其与症状严重程度的统计相关性。使用极端随机树（ERT）回归器选择与症状严重程度相关的问题，以编制一份综合问卷。为了识别新亚型，分别使用均匀流形逼近与投影和谱聚类进行非线性降维和聚类。使用某些指标（如可信度、轮廓系数和符合率）评估聚类的有效性。采用ERT分类器进一步验证聚类结果。多变量分析表明，SF - 36和KM补充了K - BDQ中缺乏的心理社会方面的内容。通过对综合问卷数据应用非线性聚类，识别出了FGID的四种亚型：轻度、重度、心理症状为主型和身体症状为主型。这些亚型的识别为个性化治疗策略提供了一个框架，从而有可能通过根据FGID患者独特的生物心理社会特征量身定制干预措施来提高治疗效果。
