慢性疲劳综合征82例临床分析

目的分析慢性疲劳综合征(chronicfatiguesyndrome,CFS)患者的临床表现及相关检查结果,为探索病因及治疗方案提供依据。方法对82例CFS患者建立表格病历,总结临床表现;SCL90等量表进行心理学测试;蛋白质印迹法检测血浆中抗博尔纳病病毒(Bornadiseasevirus,BDV)p24抗体;高压气相色谱分析检测红细胞膜上n6脂肪酸水平;酶学方法检测血浆左旋肉碱水平。结果CFS患者年龄主要分布在21～50岁之间,无性别差异,疲劳的伴随症状中,记忆力和/或注意力下降最为突出;大部分患者(57/82)存在SCL90结果异常;与健康对照组相比,CFS患者抗BDV p24抗体阳性检出率高11%vs0%,χ2=6.673,P=0.010],n6脂肪酸中花生四烯酸(ARA)水平明显低(P<0.05),左旋肉碱水平低(6±3)vs(8±4),t=2.025,P=0.045]。结论CFS患者以中青年多见,70%合并心理学异常,11%存在BDV感染,部分合并营养及能量代谢障碍。

Clinical characteristics of patients with chronic fatigue syndrome: analysis of 82 cases

OBJECTIVE: To analyze the clinical characteristics of Chinese patients suffering from chronic fatigue syndrome (CFS) and provide clinical and laboratory evidence for the study of its etiology and treatment. METHODS: 82 patients with CFS diagnosed based on the CDC criteria 1994 were recruited. History was collected, and physical examination was made. SCL-90 and memory test were used, and Hamilton Anxiety Rating Scale was used to those showing depression and/or anxiety. Laboratory examination, including examination of electrolytes, blood sugar, creatinine, bilirubin, alkaline phosphatase, alanine trasaminase, etc, was conducted. Western blotting was used to detect the protein-24 of Borna disease virus (BDV) in the plasma of 61 patients and 73 healthy controls. High-pressure chromatography was conducted to detect n-6 fatty acids on the membrane of erythrocytes of 42 patients and 37 healthy controls. Plasma L-carnitine in 61 patients and 73 healthy controls was detected by zymological analysis. In different examinations sex and age-matched controls were used. RESULTS: Most of the patients were 21 approximately 50 years old (74/82, 90.24%). No gender difference was found. The patients usually had 4 approximately 6 symptoms besides distinctive fatigue. Descent of remembrance and/or attention was the most conspicuous accompanying symptoms (69/82, 84.15%). Abnormalities in SCL-90 scores were present in 57 patients (69.51%), e.g, somatization existed most commonly (32/82, 39.02%), and anxiety and depression were 20.73% (17/82) and 18.29% (15/82) respectively. The prevalence of anti-BDV-p24 antibody was 20.73% (17/82), significantly higher than that of the controls (0%, chi(2) = 6.673, P = 0.010). The arachidonic acid level was significantly lower in the CFS group than in the controls (P > 0.05) and there were no differences in linoleic acid and ETA (both P > 0.05). The level of L-carnitine was 6.4336 +/- 3.4225, significantly lower than that of the control group (7.6666 +/- 3.5819, t = 2.025, P = 0.045) and the L-carnitine level was increased 2 weeks after supplementary treatment, together with improvement of symptoms. CONCLUSION: Most of the CFS patients are young and middle-aged. Descent of reorganization is common in these patients. Psychological abnormalities exist in most patients. Some patients are infected with BDV, some with deficiency of nutrition and/or abnormality of energy metabolism.