慢性疲劳综合征

本文就慢性疲劳综合征的命名、临床特点,诊断标准、病因、治疗进展及展望作一概述。部分学者认为社会及心理因素为本病的潜在诱因,并将认知行为疗法引入治疗并获得了一定效果。     

舍曲林治疗慢性疲劳综合征疗效观察

目的：探讨舍曲林治疗慢性疲劳综合征的疗效。方法：应用舍曲林治疗慢性疲劳综合征患者3：2例，治疗前后采用90项症状清单(SCL-90)量表进行对照研究。结果：经舍曲林治疗临床症状有显著改善，量表因子中躯体化、睡眠障碍、抑郁、焦虑、人际关系因子分明显减少。结论：舍曲林是治疗慢性疲劳综合征有效措施之一。     

慢性疲劳综合征的发病机制

慢性疲劳综合征是一种以慢性疲劳为主要表现的临床综合征,其可影响身体的多个器官及免疫系统,但发病原因至今仍是未解之谜。其病理生理过程欠清,发病机制复杂。近年发现,病毒感染、神经内分泌紊乱、自身免疫功能异常、氧化应激和遗传等因素可能参与其发病机制和病理生理过程。     

慢性疲劳综合征中的病毒感染性因素研究进展

慢性疲劳综合征发病日益增多,然而其病因和发病机制尚不明确,近年来研究表明本病发病可能与病毒感染相关。本文着重介绍EB病毒、人类疱疹病毒、博尔纳病病毒、肠道病毒和巨细胞病毒等与该病的关系。同时探讨可能的作用机制,目前较一致的观点认为病毒感染导致了机体免疫功能的异常,由此所引发的自然杀伤细胞功能与活性的变化和细胞因子调节作用的改变直接导致了中枢神经系统的损伤。     

慢性疲劳综合征的睡眠脑电图研究

目的 探讨慢性疲劳综合征患者在睡眠状态下脑电生理活动的变化.方法 应用日本Nihon Kohden公司的Neurofax-1518K多导睡眠生理仪,采用眼电图和下颌肌电图及脑电图技术,对25例慢性疲劳综合征患者和33名正常对照者进行多导睡眠图(PSG)整夜监测.结果 与正常对照组比较,慢性疲劳综合征组总记录时间延长[(488.7±21.7)分对(515.9±31.7)分,P＜0.05],睡眠潜伏期延长[(19.9±9.8)分对(40.1±11.7)分,P＜0.01],第1阶段睡眠增加[(9.1±1.9)%对(14.9±7.9)%,P＜0.01],第2阶段睡眠减少[(56.2±4.7)%对(48.8±18.7)%,P＜0.05],以及与神经症相似的REM结果(REM潜伏期前移,REM活动量、强度和密度)均增加.结论 慢性疲劳综合征组的睡眠结构紊乱类似于神经症.     

不同感染状态下的EB病毒蛋白表达与慢性疲劳

ＥＢ病毒可以潜伏感染的形式使宿主终射携带病毒,并间歇性活化。本综述不同感染状态下ＥＢＶ的蛋白表达,以及这种“潜伏活化”机制与某些慢性疲劳的关系。     

不同感染状态下的EB病毒蛋白表达与慢性疲劳

EB病毒可以潜伏感染的形式使宿主终身携带病毒 ,并间歇性活化。本文综述不同感染状态下 EBV的蛋白表达 ,以及这种“潜伏活化”机制与某些慢性疲劳的关系。     

老年神经症vs脑器质性综合征

病史摘要：夏XX，女性，72岁，丧偶，农民，入院时间：2004年2月2日     

慢性酒精中毒致柯萨科夫综合征1例报告

慢性酒精中毒在临床上很常见 ,但由其引起柯萨科夫综合征者尚属少见 ,且其预后差 ,应引起高度重视 ,现报告病例如下。患者 ,男 ,42岁 ,长期饮酒 2 0余年 ,每日约半斤 ,1年前开始出现近记忆力减退 ,说过的话、做过的事、接触过的人很快忘记。 1个月前上述症状加重 ,经常发生迷路、不认家门、将爱人错认他人 ,张冠李戴 ,编造或虚构一些不存在的事情 ,前后矛盾。查体 :体温 36 .5℃ ,血压 16 / 10 k Pa,表情淡漠 ,时间、空间及人物定向力差 ,逆行性遗忘 ,计算力差 ,10 0 - 7不能 ,颅神经 ( - ) ,四肢肌力 V级 ,右侧肢体轻度共济运动失调 ,四肢…     

Alcohol use in chronic fatigue syndrome

OBJECTIVE: To examine the anecdotal observation that patients with chronic fatigue syndrome develop alcohol intolerance. METHODS: A consecutive case series of 114 patients fulfilling UK criteria for chronic fatigue syndrome referred to a specialist clinic. Self-reported alcohol use pre- and postdiagnosis, fatigue symptoms and comorbidity measures were collected. RESULTS: Two-thirds reduced alcohol intake. The most common reasons were increased tiredness after drinking (67%), increased nausea (33%), exacerbated hangovers (23%) and sleep disturbance (24%). One-third of the subjects also stopped drinking because "it seemed sensible." Some had been advised to avoid alcohol, but the majority (66%) did so on the basis of personal experience. CONCLUSION: Our data supports the anecdotal belief that chronic fatigue syndrome patients reduce or cease alcohol intake. This is associated with greater impairment in employment, leisure and social domains of function, and may hint at psycho-pathophysiological processes in common with other conditions that result in alcohol intolerance.     

Deviations in daily physical activity patterns in patients with the chronic fatigue syndrome: a case control study

Objectives

Deviations in daily physical activity patterns may play an important role in the development and maintenance of fatigue in the chronic fatigue syndrome (CFS). The aim of this study is to gain insight into the objective daily physical activity pattern of patients with CFS in comparison with healthy controls. The secondary objective is studying the awareness in performing physical activities.

Methods

The objective daily physical activity pattern was measured with a tri-axial accelerometer in 35 patients with CFS and in 35 age- and gender-matched healthy controls. The objective daily physical activity level and distribution of physical activities at low, medium and high intensity levels during the day were measured. Moreover, variability in performing physical activities within and between subjects was computed. Subjective ratings of self-reported daily physical activity levels were assessed at a visual analog scale.

Results

CFS patients were significantly less physically active in the afternoon and evening, and spent fewer activities at high intensity levels and more at low intensity levels. Moreover, CFS patients showed more variability in their own physical activity pattern during the afternoon. The heterogeneity in the physical activity pattern between subjects within the CFS and control group did not differ. Finally, CFS patients were more aware about their daily physical activity level than healthy controls.

Conclusion

CFS patients showed deviations in the objectively measured daily physical activity pattern. Future research should elucidate the relation between impaired balances in daily physical activity patterns and fatigue severity in CFS.     

Coping strategies in twins with chronic fatigue and chronic fatigue syndrome

Objectives: Individuals with chronic fatigue and chronic fatigue syndrome (CFS) face debilitating symptoms as well as stressful life situations that may result from their condition. The goal of this study was to examine the coping strategies used by fatigue-discordant twin pairs. Methods: We utilized a co-twin design to assess how twin pairs discordant for chronic fatigue and CFS cope with stress. All twin pairs were administered the Revised Ways of Coping Checklist. Results: Overall, the pattern of coping strategies was similar for fatigued and non-fatigued twins. However, twins with chronic fatigue or CFS utilized more avoidance strategies than their non-fatigued counterparts; those with chronic fatigue also used more avoidance relative to problem-focused coping than their co-twins. Conclusions: These results suggest that while fatigue-discordant twins generally exhibit similar behavior patterns in order to cope with stress, there may be an association between fatigue and avoidance coping. Future research should focus on the role of avoidance and its relationship to fatiguing illnesses.     

Well-being in patients with chronic fatigue syndrome: the role of acceptance

OBJECTIVE: Research in chronic pain patients has shown that accepting the chronic nature of their illness is positively related to quality of life. The aim of this study was to investigate whether acceptance is also associated with better well-being in patients suffering from chronic fatigue syndrome (CFS). METHODS: Ninety-seven patients completed a battery of questionnaires measuring fatigue, functional impairment, psychological distress, and acceptance. RESULTS: Results indicated that acceptance has a positive effect upon fatigue and psychological aspects of well-being. More specifically, acceptance was related to more emotional stability and less psychological distress, beyond the effects of demographic variables, and fatigue severity. CONCLUSION: We suggest that promoting acceptance in patients with CFS may often be more beneficial than trying to control largely uncontrollable symptoms.     

Association of medically unexplained fatigue with ACE insertion/deletion polymorphism in Gulf War veterans

Genes associated with muscle metabolism and physical endurance were evaluated for variants that may contribute to the etiology of medically unexplained severe and chronic fatigue. Subjects included 49 Gulf War veterans and 61 nonveterans with chronic fatigue syndrome (CFS) or idiopathic chronic fatigue (ICF) and 30 veterans and 45 nonveterans who served as healthy controls. Increased risk for CFS/ICF was associated with alterations of the insertion/deletion (I/D) polymorphism in the angiotensin-converting enzyme gene within the Gulf War veteran sample only. The I allele frequency was decreased in affected versus unaffected veterans (0.15 versus 0.48; odds ratio [OR], 5.08; 95% confidence interval [CI], 1.97-13.35; P < 0.0001). Correspondingly, the II genotype was decreased fourfold in affected veterans (0.08 versus 0.35; OR = 5.87; 95% CI: 1.21-28.36; P = 0.02), and the DD genotype was increased twofold (0.78 versus 0.39; OR, 5.4; 95% CI, 1.6-18.4; P = 0.007). Veterans with the DD genotype were eight times more likely to develop CFS/ICF than were those with the II genotype (OR, 8.30; 95% CI, 1.50-56.09; P = 0.009).     

Determinants of health care use in chronic fatigue syndrome patients: a cross-sectional study

BACKGROUND: Chronic fatigue syndrome (CFS) is associated with a high use of health care services. To reduce the related costs for patients and society, it will be useful to know which factors determine CFS patients' amount of health care use. Little is known, however, about these factors. METHOD: The present study retrospectively performed a cross-sectional analysis to investigate the possible factors determining CFS patients' health care use. A total of 263 CFS patients, derived from two subgroups (149 from tertiary care and 114 from primary/secondary care), participated. Health care use was measured with a questionnaire asking details on consumption over the past 6 months. Fatigue severity and physical functioning were measured with the subscale Experienced Fatigue of the Checklist Individual Strength (CIS-20) and the subscale Physical Functioning of the SF-36, respectively. Multiple regression analysis, T-tests, and chi(2) tests were performed. RESULTS: The regression analysis revealed that, after controlling for patient characteristics (explaining 13%), fatigue factors added 4% predictive value and certain perpetuating factors of fatigue, including focus on bodily symptoms and attributions of fatigue, added another 5%. The analysis of subgroups revealed that, compared to the tertiary care population, fewer patients from primary/secondary care had visited a medical specialist (50% vs. 71%), used antidepressants (16% vs. 25%) and tranquilizers (3% vs. 18%), and had spent a night in hospital (7% vs. 10%). However, overall costs of health care between these subgroups did not differ. CONCLUSIONS: This study showed that illness duration, physical impairment due to fatigue, and psychological perpetuating factors of fatigue do determine the variance in CFS patients' health care use. These results give clear directions for treating CFS patients and managing health care for CFS.     

Alexithymia in adolescents with chronic fatigue syndrome

BACKGROUND: Alexithymia is postulated as an important factor in the development of medically unexplained physical symptoms. Chronic fatigue syndrome (CFS) is presently medically unexplained. The aim of this study was to investigate whether the prevalence of alexithymia was higher in adolescents with CFS compared to healthy adolescents. Comorbidity such as anxiety and depression were analyzed as possible confounding factors. Secondly, alexithymia was investigated as a prognostic factor for the recovery of CFS. METHODS: A cross-sectional study was performed among 40 adolescent outpatients diagnosed with CFS and 36 healthy controls. The 20-item Toronto Alexithymia Scale was used to assess all participants for alexithymia. Additionally, all participants completed a number of questionnaires regarding fatigue (Checklist Individual Strength), somatic complaints (Checklist Somatization Inventory), depression (Children's Depression Inventory), and trait anxiety (Spielberger State Trait Anxiety Questionnaire). A follow-up study was performed among the CFS adolescents 1 1/2 years after the initial assessment. RESULTS: CFS adolescents scored higher only on the subscale identifying feelings of the TAS-20 [mean difference after adjustment for depression and anxiety 2.8 (95% CI: 0.6; 4.9]. Twelve CFS adolescents (30%) fulfilled criteria for alexithymia. This subgroup was characterized by higher scores for depression and anxiety and equal scores for fatigue and somatic complaints. At follow-up, no differences in recovery were established between the alexithymic and nonalexithymic CFS adolescents. CONCLUSIONS: Alexithymia neither appears to be a unique correlate of CFS nor to be a prognostic factor for recovery of the CFS illness.     

Actigraphic assessment of sleep disorders in children with chronic fatigue syndrome

Children with chronic fatigue syndrome (CFS) often suffer from sleep disorders, which cause many physiological and psychological problems. Understanding sleep characteristics in children with CFS is important for establishing a therapeutic strategy. We conducted an actigraphic study to clarify the problems in sleep/wake rhythm and physical activity in children with CFS. METHODS: Actigraphic recordings were performed for 1-2 weeks in 12 CFS children. The obtained data were compared with those of healthy age-matched children used as the control. RESULTS: Sleep patterns were divided into two groups based on subjects' sleep logs: irregular sleep type and delayed sleep phase type. Compared to the control group, total sleep time was longer and physical activity was lower in both groups of CFS. Continuous sleep for more than 10h was not uncommon in CFS. In the irregular sleep type, impaired daily sleep/wake rhythms and disrupted sleep were observed. CONCLUSION: Using actigraphy, we could identify several characteristics of the sleep patterns in CFS children. Actigraphic analysis proved to be useful in detecting sleep/wake problems in children with CFS.     

A longitudinal study of physical activity and body mass index among persons with unexplained chronic fatigue

OBJECTIVE AND METHODS: A cohort of 100 patients with unexplained chronic fatigue (CF) was assessed longitudinally for 1.5 years to determine if physical activity (kcal expended), exercise capacity (VO(2)max), perceived exertion, and body mass index (BMI) changed over time and were associated with changes in CF-related clinical status. RESULTS: BMI increased significantly over time but did not predict changes in clinical status. Increasing energy expenditure was associated with increasing vitality and decreasing CF symptom severity over time, and decreasing perceived exertion was associated with increasing physical functioning. However, increasing perceived exertion was also associated with increasing CF symptoms. CONCLUSIONS: These data do not support models that posit associations between CF and deconditioning.