Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis
Extended phenotype and clinical subgroups in unilateral Meniere disease: A cross-sectional study with cluster analysis
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DOI：
10.1111/coa.12844
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发表时间：
2017-12-01
影响因子：
2.1
通讯作者：
Lopez-Escamez, J. A.
中科院分区：
文献类型：
--
作者：
Frejo, L.;Martin-Sanz, E.;Lopez-Escamez, J. A.
目的通过聚类分析确定单侧梅尼埃病(MD)患者的临床亚型，并将其与双侧MD的临床亚型进行比较。设计一项横断面研究，采用两步聚类分析。设置一项第三方转诊多中心研究。研究对象：成人单侧MD患者9例。主要观察指标：确定具有潜在不同病因的临床亚组的最佳预测因子。结果我们在单侧MD中建立了5个分类。第一组是最常见的，包括53%的患者，它被定义为没有偏头痛和没有自身免疫性疾病(AD)的散发的、典型的MD。第二组有8%的患者，其定义是听力损失，它比眩晕发作早几个月或几年(延迟性MD)，在大多数病例中没有偏头痛或AD。第三组涉及13%的患者，被认为是家族性MD，而第四组，包括15%的患者，与所有病例的偏头痛有关。第5组在11%的患者中被发现，并由并存的AD定义。我们发现AD在单侧和双侧MD3、4和5簇中的分布有显著差异。结论聚类分析确定了MD的临床亚型，它将表型扩展到听前庭症状之外。这种分类将有助于改善MD的表型，并促进随机临床试验患者的选择。
ObjectivesTo define clinical subgroups by cluster analysis in patients with unilateral Meniere disease (MD) and to compare them with the clinical subgroups found in bilateral MD.DesignA cross-sectional study with a two-step cluster analysis.SettingsA tertiary referral multicenter study.ParticipantsNine hundred and eighty-eight adult patients with unilateral MD. Main outcome measures: best predictors to define clinical subgroups with potential different aetiologies.ResultsWe established five clusters in unilateral MD. Group 1 is the most frequently found, includes 53% of patients, and it is defined as the sporadic, classic MD without migraine and without autoimmune disorder (AD). Group 2 is found in 8% of patients, and it is defined by hearing loss, which antedates the vertigo episodes by months or years (delayed MD), without migraine or AD in most of cases. Group 3 involves 13% of patients, and it is considered familial MD, while group 4, which includes 15% of patients, is linked to the presence of migraine in all cases. Group 5 is found in 11% of patients and is defined by a comorbid AD. We found significant differences in the distribution of AD in clusters 3, 4 and 5 between patients with uni- and bilateral MD.ConclusionsCluster analysis defines clinical subgroups in MD, and it extends the phenotype beyond audiovestibular symptoms. This classification will help to improve the phenotyping in MD and facilitate the selection of patients for randomised clinical trials.