Are current chronic fatigue syndrome criteria diagnosing different disease phenotypes?
Are current chronic fatigue syndrome criteria diagnosing different disease phenotypes?
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DOI：
10.1371/journal.pone.0186885
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Newton JL
中科院分区：
文献类型：
--
作者：
Maclachlan L;Watson S;Gallagher P;Finkelmeyer A;Jason LA;Sunnquist M;Newton JL
慢性疲劳综合征（CFS）的特点是一系列的症状诊断与一些不同的多方面的标准。这些诊断标准的异质性可能会混淆对这种污名化和衰弱性疾病的病理生理学的研究，并可能诊断出对临床管理具有重大意义的疾病谱。迄今为止，还没有研究使用经过验证的CFS量表-DePaul症状问卷（DSQ）客观地调查这种可能性。检查当前CFS诊断标准是否使用DSQ识别不同的疾病表型。病例对照研究。皇家维多利亚医院临床研究机构，英国泰恩河畔纽卡斯尔。49名CFS受试者和10名匹配的久坐社区对照，排除了共病抑郁症。采用自主神经综合症状评分（COMPASS）和认知功能障碍问卷（COGFAIL）对患者的自主神经功能和认知功能进行评估。使用Task Force®监测器和一系列神经心理学测试检查客观自主心血管参数，以进行客观认知评估。CFS患者自我报告的自主神经和认知症状显著高于对照组。CFS和对照组之间的客观自主神经测量值无统计学显著差异。在客观自主神经测试方面，DSQ亚组之间存在临床显著差异。DSQ各亚组间的视觉空间记忆、言语记忆和心理速度差异有统计学意义。CFS和对照组受试者之间客观自主神经测试无显著差异的发现可能反映了纳入久坐对照或排除共病抑郁。一致的排除标准可以更好地描述这两种情况及其表现症状。CFS亚组的结果表明，当使用DSQ分类时，受试者在功能、自主参数和认知障碍的主观和客观测量方面具有不同的疾病负担。不同的CFS标准最好可能是诊断疾病严重程度的谱，最坏可能是诊断不同的CFS表型或甚至不同的疾病。这使研究和疾病管理复杂化，并可能导致与该疾病相关的严重耻辱。
Chronic fatigue syndrome (CFS) is characterised by a constellation of symptoms diagnosed with a number of different polythetic criteria. Heterogeneity across these diagnostic criteria is likely to be confounding research into the as-yet-unknown pathophysiology underlying this stigmatised and debilitating condition and may diagnose a disease spectrum with significant implications for clinical management. No studies to date have objectively investigated this possibility using a validated measure of CFS symptoms–the DePaul Symptom Questionnaire (DSQ). To examine whether current CFS diagnostic criteria are identifying different disease phenotypes using the DSQ. Case control study. Clinical Research Facility of the Royal Victoria Infirmary, Newcastle upon Tyne, UK. 49 CFS subjects and ten matched, sedentary community controls, excluded for co-morbid depression. Self-reported autonomic and cognitive features were assessed with the Composite Autonomic Symptom Score (COMPASS) and Cognitive Failures Questionnaire (COGFAIL) respectively. Objective autonomic cardiovascular parameters were examined using the Task Force® Monitor and a battery of neuropsychological tests administered for objective cognitive assessment. Self-reported autonomic and cognitive symptoms were significantly greater in CFS subjects compared to controls. There were no statistically significant differences in objective autonomic measures between CFS and controls. There were clinically significant differences between DSQ subgroups on objective autonomic testing. Visuospatial memory, verbal memory and psychomotor speed were significantly different between DSQ subgroups. The finding of no significant differences in objective autonomic testing between CFS and control subjects may reflect the inclusion of sedentary controls or exclusion for co-morbid depression. Consistent exclusion criteria would enable better delineation of these two conditions and their presenting symptoms. Findings across CFS subgroups suggest subjects have a different disease burden on subjective and objective measures of function, autonomic parameters and cognitive impairment when categorised using the DSQ. Different CFS criteria may at best be diagnosing a spectrum of disease severities and at worst different CFS phenotypes or even different diseases. This complicates research and disease management and may contribute to the significant stigma associated with the condition.
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DOI：
10.1080/21641846.2014.978110
发表时间：
2015-01-01
期刊：
Fatigue : biomedicine, health & behavior
影响因子：
--
作者：
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影响因子：
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