Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study.
Dysmenorrhea Symptom-Based Phenotypes: A Replication and Extension Study.
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DOI：
10.1097/nnr.0000000000000477
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发表时间：
2021
期刊：
影响因子：
2.5
通讯作者：
Fortenberry JD
中科院分区：
文献类型：
--
作者：
Chen CX;Carpenter JS;Ofner S;LaPradd M;Fortenberry JD
痛经是女性中普遍存在的疼痛状况，也是其他慢性疼痛状况的危险因素。个体痛经疼痛的严重程度、疼痛部位的数量和同时发生的胃肠道症状各不相同。三种痛经症状为基础的表型先前被确定使用潜在类分析；然而，有必要在一个独立的样本中验证这些，以便它们可以用于机械和介入性研究。还需要进一步从人口学、临床和心理行为特征方面对痛经症状的表型进行表征，以便它们可以用于精确的痛经治疗。该研究的目的是：(a)确定在新的样本中是否会发现相同的痛经症状表型；(b)确定在潜在分类分析中纳入人口学、临床和心理行为协变量是否会改变个体的表型成员；(c)调查痛经症状表型与人口学、临床和心理行为特征之间的关系。这项横断面调查研究包括678名患有痛经的女性（14至42岁）。参与者报告痛经症状严重程度、人口统计学、临床（共病慢性疼痛和妇科疾病）和心理行为特征（感知压力、焦虑、抑郁、睡眠障碍和疼痛灾难化）。我们使用潜在分类分析来确定基于症状的表型。我们比较了有协变量和没有协变量（即人口统计学、临床和心理行为特征）的分析，以确定个体的表型成员是否发生了变化。然后，我们检查了表型与人口学、临床和心理行为特征之间的关系。我们重现了三种基于痛经症状的表型：“轻度局部疼痛”表型（以轻度腹部痉挛为特征）、“严重局部疼痛”表型（以严重腹部痉挛为特征）和“多重严重症状”表型（以多处严重疼痛和胃肠道症状为特征）。有或没有协变量的分析对个体的表型隶属性影响不大。种族、共病慢性疼痛状况、子宫内膜异位症和疼痛灾变与痛经表型显著相关。研究结果为进一步研究痛经症状异质性机制和制定痛经精准治疗提供了基础。在第二个样本中验证了三种基于痛经症状的表型。人口学、临床和心理行为因素与痛经症状相关。
Dysmenorrhea is a prevalent pain condition among women and a risk factor for other chronic pain conditions. Individuals vary in dysmenorrhea pain severity, the number of painful sites, and co-occurring gastrointestinal symptoms. Three dysmenorrhea symptom-based phenotypes were previously identified using latent class analysis; however, there is a need to validate these in an independent sample, so they can be used in mechanistic and interventional research. There also is a need to further characterize dysmenorrhea symptom-based phenotypes in terms of demographic, clinical, and psychobehavioral characteristics so they can be used to inform precision dysmenorrhea treatment. The study objectives were to: (a) determine whether the same dysmenorrhea symptom-based phenotypes would be found in a new sample; (b) determine whether including demographic, clinical, and psychobehavioral covariates in latent class analyses would change individuals’ phenotype memberships; and (c) investigate relationships between dysmenorrhea symptom-based phenotypes and demographic, clinical, and psychobehavioral characteristics. This cross-sectional survey study included 678 women (aged 14 to 42 years) with dysmenorrhea. Participants reported dysmenorrhea symptom severity, demographic, clinical (comorbid chronic pain and gynecological conditions), and psychobehavioral characteristics (perceived stress, anxiety, depression, sleep disturbance, and pain catastrophizing). We used latent class analysis to identify symptom-based phenotypes. We compared analyses with and without covariates (i.e., demographic, clinical, and psychobehavioral characteristics) to determine if individuals’ phenotype memberships changed. We then examined associations between phenotypes and demographic, clinical, and psychobehavioral characteristics. We reproduced three dysmenorrhea symptom-based phenotypes: the “mild localized pain” phenotype (characterized by mild abdominal cramps), the “severe localized pain” phenotype (characterized by severe abdominal cramps), and the “multiple severe symptoms” phenotype (characterized by severe pain at multiple locations and gastrointestinal symptoms). Analyses with and without covariates had little effect on individuals’ phenotype membership. Race, comorbid chronic pain condition, endometriosis, and pain catastrophizing were significantly associated with the dysmenorrhea phenotypes. Findings provide a foundation to further study mechanisms of dysmenorrhea symptom heterogeneity and develop dysmenorrhea precision treatments. The three dysmenorrhea symptom-based phenotypes were validated in a second sample. Demographic, clinical, and psychobehavioral factors were associated with dysmenorrhea symptom-based phenotypes.