MRI研究慢性疲劳综合征脑结构及功能进展

2016年WHO国际疾病分类将慢性疲劳综合征(CFS)归为神经系统其他疾病,脑结构及功能异常在CFS发病过程中具有关键作用。MRI有助于观察脑结构及功能变化,为诊断CFS及解析其发病机制提供影像学依据。本文就MRI研究CFS脑结构及功能进展进行综述。     

慢性疲劳综合征的临床特征与研究进展

目的:慢性疲劳综合征(chronicfatiguesyndrome,CFS)是一组以疲劳为主的综合症候群,大多数给不出确切的病理解剖学诊断。研究CFS以利于临床医生对本疾病足够重视,以便正确诊断,早期干预,促进CFS患者早日康复。资料来源:以“慢性疲劳综合征”为主题词全面检索美国国家图书馆医学在线(Medline)数据库和万方数据库,获取CFS的全部资料和信息。资料选择:对获取的资料以“intitle”、“2000/2004”加以限制,筛选出近5年的主题文献,并对重点文献的主要参考文献进行手工检索追踪相关全文。文献包括基础研究和临床研究。资料提炼:37篇关于CFS的文献,29篇符合标准,排除的8篇文献是重复的同一研究,对剩余的29篇关于CFS主题文献全文中的相关信息进行分类综合研究。资料综合:CFS主要表现为持续或反复发作的疲劳和躯体疼痛、失眠、情绪抑郁和免疫功能异常。临床检查多无明显器质性改变。就其病因主要有两种学说:生物感染和由感染直接介导的免疫功能失调,另外,可能与神经内分泌紊乱、营养物缺乏、过度劳累、心理等因素相关。CFS与纤维肌痛综合征、肌纤维疼痛综合征、抑郁症等部分交叉和重叠。CFS的治疗方法很多,如药物治疗、营养支持、行为认知疗法和有氧运动疗法等,但都是非特异性的。结论:研究表明应该针对不同的患病     

青少年慢性疲劳综合征的诊断现状分析

慢性疲劳综合征(chronic fatigue syndrome,CFS)是一种以持续不缓解的病态性疲劳为特征的疾病,严重影响患者的身心健康。既往关于CFS的研究大多聚焦于成年人,较少开展对青少年群体的针对性研究。研究显示,青少年CFS患者患病率逐年增高,由于诊断困难、治疗不当等原因导致部分患者预后不佳,加大对青少年CFS的研究力度极为必要。本文对青少年CFS的诊断标准、漏诊原因及研究进展进行总结,以期为青少年CFS的诊断及治疗提供新的思路。     

PET在癫痫定位诊断中的应用

目的：更深入的了解PET在癫痫定位诊断中的作用。方法：复习国内外近年来相关研究结果及文献。结果：PET足一种非侵入性的影像学俭查方法,包括代谢显像和神经受体显像等,在癫痫定位诊断中具有较高的特异性和准确度,不仅能发现形态结构异常还能发现功能异常的病灶：结论：PET显像在癫痫定位诊断中具有重要的意义。     

PET最新进展

概述 PET问世于1974年,当时主要用于脑和心脏功能显像的实验研究。与进行器官结构显像的CT和MRI不同,它是反映器官代谢功能改变的显像。CT和MRI只能提供解剖结构异常的图象信息,但无法确定异常病灶的性质而PET的功能正好与其相反,能够提供有关异常病灶定性的信息。近年来,随着PET硬件和软件的发展,特别是PET全身扫描的临床应用,使PET在多种疾病诊断的价值明显提高,尤其在肿瘤诊断和分期方面越来越引起临床医生的重视。但PET仪器价格和检查费用的昂贵,影响了它的发展。 自从80年代PET在脑部疾病诊断开始临床应用以来,20年过去了。它的发展如何,一直是核医学界,乃至整个医学界关心的问题,本文就其技术,临床应用和医保方面的发展,做一详细回顾, PET最新发展情况 PET技术不断向前发展,从传统的Siemens和GE统治PET全球市场,发展到PET新军ADAC雄起的三     

慢性疲劳综合征的临床特征与研究进展

目的：慢性疲劳综合征(chronic fatigue syndrome，CFS)是一组以疲劳为主的综合症候群，大多数给不出确切的病理解剖学诊断。研究CFS以利于临床医生对本疾病足够重视，以便正确诊断，早期干预，促进CFS患早日康复。资料来源：以“慢性疲劳综合征”为主题词全面检索美国国家图书馆医学在线(Medline)数据库和万方数据库，获取CFS的全部资料和信息。资料选择：对获取的资料以“intitle”、“2000／2004”加以限制，筛选出近5年的主题献，并对重点献的主要参考献进行手工检索追踪相关全。献包括基础研究和临床研究。资料提炼：37篇关于CFS的献，29篇符合标准，排除的8篇献是重复的同一研究，对剩余的29篇关于CFS主题献全中的相关信息进行分类综合研究。资料综合：CFS主要表现为持续或反复发作的疲劳和躯体疼痛、失眠、情绪抑郁和免疫功能异常。临床检查多无明显器质性改变。就其病因主要有两种学说：生物感染和由感染直接介导的免疫功能失调，另外，可能与神经内分泌紊乱、营养物缺乏、过度劳累、心理等因素相关。CFS与纤维肌痛综合征、肌纤维疼痛综合征、抑郁症等部分交叉和重叠。CFS的治疗方法很多，如药物治疗、营养支持、行为认知疗法和有氧运动疗法等，但都是非特异性的。结论：研究表明应该针对不同的患病个体采取个性化或是综合性疗法，才有可能取得理想疗效。     

慢性疲劳综合征的中医特色疗法研究进展

本文通过检索国内外相关文献,对中医护理特色疗法治疗慢性疲劳综合征（CFS）的相关研究进行综述,从CFS的病因机制、辨证分型、中西医治疗在CFS患者护理中的临床应用等方面进行总结概括,以期为中医护理特色疗法在临床上的灵活运用提供借鉴。     

^18F-脱氧葡萄糖PET对非恶性肿瘤摄取的分析与识别

目的 探讨PET表现特殊的非肿瘤性异常放射性摄取的原因,提出鉴别诊断方法.方法 对2004年8月～2008年8月18F-脱氧葡萄糖(18F-FDG)PET全身显像表现为局部明显异常放射性摄取,经病理或临床随访证实为非恶性肿瘤98例的PET、CT图像进行综合分析,总结鉴别诊断要点.结果 本组PET图像均显示有明显异常的局限性放射性摄取,绝大多数浓聚灶标准化摄取值(SUV)最大值超过2.5,其中2例曾误诊为恶性肿瘤.98例中证实为感染与炎症病变46例,生理性摄取28例,良性病变24例.结论 在18F-FDGPET全身显像中,非恶性病变放射性摄取在PET、CT图像以及临床上各有特点,易误诊,应予以高度重视.     

PET/CT融合图像诊断甲状腺癌——与CT、SPECT或PET的比较研究

目的通过与CT、SPECT或PET的对比研究,探讨PET/CT诊断甲状腺癌的价值.方法收集经随访、手术或活检、病理证实的甲状腺癌12例,CT检查12例,SPECT检查5例,PET检查7例,PET/CT检查12例,分别观察、记录病灶数目、位置、大小、核素分布、钙化等.结果12例共有病灶19个,CT显示病灶13个,SPECT静态显像发现病灶6个,灌注显像全部病灶血流灌注增加,PET发现放射性浓聚影9个,PET/CT见到异常高代谢区19个.结论CT图像能清晰显示病变形态、密度;核医学图像可提供病灶代谢信息;PET/CT图像可同时观察病灶解剖与功能信息,提高了定位、定性诊断能力.     

PET/CT检查在乳腺癌患者复发中的作用

目的研究乳腺癌患者血清肿瘤标志物出现异常后,PET/CT对早期发现乳腺癌复发的部位,及早进行治疗的价值。方法 82位乳癌患者,术后行常规复查时,出现1项或多项肿瘤标志物增高,常规行CT检查,检查后1-3个月内行PET/CT检查。当影像学检查提示阳性结节后,结果的最终判定是通过组织病理学诊断及随访。结果 PET/CT检查提示异常结节368个。真阳性：310个,假阳性：11个,真阴性：41个,假阴性：6个。在82名患者中,确诊为复发的真阳性患者：38名,假阳性：11名,真阴性：28名,假阴性：5名。结论乳腺癌患者血清肿瘤标志物异常后,PET/CT诊断复发的敏感性、特异性、准确性指标均高于CT。     

Neuro-psychiatric aspects of chronic fatigue syndrome]

Chronic fatigue syndrome (CFS) is easily differentiated from various neurological organic disorders by conventional clinical examinations. The most important disease for distinguishment from CFS is fibromyalgia syndrome, in which the prominent and cardinal feature is a deprivation of stage 4 slow wave sleep. Experimentally, the sleep disturbance in controls can induce general myalgia, muscle tender points, severe fatigue and stiffness on awakening. The EEG abnormality is slow alpha wave contaminants on slow wave background, which is identical to EEG of CFS. The results clearly imply that CFS is not a hysterical or psychogenic disease, and that fibromyalgia may be a central fundamental of CFS. Fibromyalgia, however, has distinct features such as no antecedent inflammatory process and no endemics. Therefore, the syndrome has features distinct from, in addition to common features to CFS. It is also very difficult to distinguish CFS from depression. The above-mentioned features can be observed in depression. Now, study of brain blood flow or metabolism by PET or SPECT can be a possible tool for establishment of the CFS identity.     

Gray matter volume reduction in the chronic fatigue syndrome

The chronic fatigue syndrome (CFS) is a disabling disorder of unknown etiology. The symptomatology of CFS (central fatigue, impaired concentration, attention and memory) suggests that this disorder could be related to alterations at the level of the central nervous system. In this study, we have used an automated and unbiased morphometric technique to test whether CFS patients display structural cerebral abnormalities. We mapped structural cerebral morphology and volume in two cohorts of CFS patients (in total 28 patients) and healthy controls (in total 28 controls) from high-resolution structural magnetic resonance images, using voxel-based morphometry. Additionally, we recorded physical activity levels to explore the relation between severity of CFS symptoms and cerebral abnormalities. We observed significant reductions in global gray matter volume in both cohorts of CFS patients, as compared to matched control participants. Moreover, the decline in gray matter volume was linked to the reduction in physical activity, a core aspect of CFS. These findings suggest that the central nervous system plays a key role in the pathophysiology of CFS and point to a new objective and quantitative tool for clinical diagnosis of this disabling disorder.     

beta-Alanine and gamma-aminobutyric acid in chronic fatigue syndrome

BACKGROUND: Due to the occurrence of sleep disturbances and fatigue in chronic fatigue syndrome (CFS), an investigation was performed to examine if there is an abnormal excretion of gamma-aminobutyric acid (GABA) and/or its structural analogue beta-alanine in the urine from CFS patients. Both GABA and beta-alanine are inhibitory neurotransmitters in the mammalian central nervous system. METHODS: The 24 h urine excretion of GABA and beta-alanine was determined by isotope dilution gas chromatography mass spectrometry in 33 CFS patients and 43 healthy controls. The degree of symptoms in both patients and controls was measured by grading of three typical CFS symptoms using a Visual Analogue Scale. RESULTS: Men had a significantly higher excretion of both beta-alanine and GABA than women. Comparing CFS patients with healthy controls showed no significant difference in excretion of neither beta-alanine nor GABA. No correlation was found between the excretion of beta-alanine or GABA and any of the three characteristic CFS symptoms measured. However, two female and two male CFS patients excreted considerably higher amounts of beta-alanine in their 24 h urine samples than control subjects. CONCLUSIONS: Increased excretion of beta-alanine was found in a subgroup of CFS patients, indicating that there may be a link between CFS and beta-alanine in some CFS patients.     

Chronic fatigue syndrome in school children]

Chronic fatigue syndrome (CFS) is characterized by persistent or relapsing debilitating fatigue for at least 6 months without any apparent medical diagnosis that would explain the clinical presentation. Although, most of the reported patients are over age 30, CFS also affects school children. To better understand CFS, the network of the central nervous-endocrine-immune systems should be considered, and one must be careful to distinct CFS from school absenteeism and other psychosomatic disorders often seen among them.     

Rehabilitation of decreased motor performance in patients with chronic fatigue syndrome: should we treat low effort capacity or reduced effort tolerance?

AIM: The aetiology, pathophysiology, diagnostic delineation and treatment of chronic fatigue syndrome (CFS) remain a matter of debate. Here some aspects of the debate are elucidated, with a particular focus on the patients' decreased motor performance. HYPOTHESIS: The pathophysiological basis of decreased motor performance in CFS may, theoretically, involve three components: (1) a peripheral energetic deficit (impaired oxidative metabolism and/or physical deconditioning); (2) a central perceptual disturbance (higher effort sense or increased 'interoception'); and (3) a fundamental failure of the neurobiological stress system, leading to an abnormal 'sickness response'. It is proposed that the first two components may lead to low effort capacity, while the third component may lead to reduced effort tolerance. Although there is evidence for low effort capacity influencing symptoms and functional limitations in CFS, it is assumed that reduced effort tolerance might be the primary disturbance in CFS. DIAGNOSTIC IMPLICATIONS: Distinguishing low effort capacity and reduced effort tolerance may contribute to a refinement of current diagnostic criteria of CFS and the identification of subgroups. THERAPEUTIC IMPLICATIONS: The above-mentioned distinction may make it possible to formulate a rationale for an effective implementation and adequate outcome evaluation of rehabilitation strategies in CFS. RESEARCH IMPLICATIONS: This new heuristic framework may inform future research aimed at disentangling the complex determination of impaired motor performance in CFS, as well as studies aimed at customizing treatment to different subtypes of patients.     

Chronic fatigue syndrome: new evidence for a central fatigue disorder

Considerable evidence points towards a prominent role for central nervous system (CNS) mechanisms in the pathogenesis of chronic fatigue syndrome (CFS), a disorder characterized chiefly by persistent, often debilitating, fatigue. We wished to characterize circulating profiles of putative amino acid modulators of CNS 5-hydroxytryptamine (5-HT; serotoninergic) and dopaminergic function in CFS patients at rest, as well as during symptom-limited exercise and subsequent recovery. Groups of 12 CFS patients and 11 age- and sex-matched sedentary controls, with similar physical activity histories, underwent ramp-incremental exercise to the limit of tolerance. Plasma amino acid concentrations, oxygen uptake and ratings of perceived exertion were measured at rest, and during exercise and recovery. Peak oxygen uptake was significantly lower in the CFS patients compared with controls. Rating of perceived exertion in the patients was higher at all time points measured, including at rest, relative to controls. Levels of free tryptophan (free Trp), the rate-limiting 5-HT precursor, were significantly higher in CFS patients at exhaustion and during recovery, whereas concentrations of branched-chain amino acids (BCAA) and large neutral amino acids (LNAA) were lower in CFS patients at exhaustion, and for LNAA also during recovery. Consequently, the [free Trp]/[BCAA] and [free Trp]/[LNAA] ratios were significantly higher in CFS patients, except at rest. On the other hand, levels of tyrosine, the rate-limiting dopaminergic precursor, were significantly lower at all time points in the CFS patients. The significant differences observed in a number of key putative CNS 5-HT and dopaminergic modulators, coupled with the exacerbated perception of effort, provide further evidence for a potentially significant role for CNS mechanisms in the pathogenesis of CFS.     

Exercise lowers pain threshold in chronic fatigue syndrome

Post-exertional muscle pain is an important reason for disability in patients who are diagnosed to have Chronic Fatigue Syndrome (CFS). We compared changes in pain threshold in five CFS patients with five age and sex matched controls following graded exercise. Pain thresholds, measured in the skin web between thumb and index finger, increased in control subjects with exercise while it decreased in the CFS subjects. Increased perception of pain and/or fatigue after exercise may be indicative of a dysfunction of the central anti-nociceptive mechanism in CFS patients.     

Chronic fatigue syndrome and neurotransmitters

Chronic fatigue syndrome (CFS) is an idiopathic illness characterized by persistent fatigue, which could be caused by a variety of etiologic factors including viral infection, abnormal production of cytokines and abnormal acylcarnitine metabolism. Recent studies suggest that CFS is closely associated with attenuation of central synaptic transmission mediated by neurotransmitters such as serotonin and glutamate. Attenuation of serotonin neurotransmission can be caused by increased expression of serotonin transporter, which results either from viral infection and subsequent production of interferon--alpha or from abnormal promoter for serotonin transporter gene. Other neurotransmitter systems may be also involved in CFS mediated by abnormal acylcarnitine metabolism and autoantibodies for neurotransmitter receptors. In this review, we focus recent data on CFS in terms of neurotransmitters.