Symptoms of autonomic dysfunction in chronic fatigue syndrome
Symptoms of autonomic dysfunction in chronic fatigue syndrome
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DOI：
10.1093/qjmed/hcm057
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发表时间：
2007-08-01
影响因子：
13.3
通讯作者：
Jones, D. E. J.
中科院分区：
文献类型：
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作者：
Newton, J. L.;Okonkwo, O.;Jones, D. E. J.
背景：慢性疲劳综合征（CFS）是一种常见的疾病，其病因尚不清楚。目的：了解慢性疲劳综合症中自主神经功能障碍的患病率，并制定诊断标准。设计：具有独立推导和验证阶段的横断面研究。方法：采用自主神经综合症状量表（COMPASS）评估自主神经功能障碍的症状。使用疲劳冲击量表（FIS）评估疲劳。受试者分为两组：第一阶段（衍生阶段），40名CFS患者和40名年龄和性别匹配的对照组；2期（验证期），30例CFS患者，37例正常对照和60例原发性胆汁性肝硬化患者。结果：自主神经功能障碍的症状与CFS或原发性胆汁性肝硬化（PBC）存在强烈且可重复的相关性，并与疲劳的严重程度相关。第一阶段确定COMPASS总分> 32.5作为CFS患者自主神经功能障碍的诊断标准，第二阶段显示其阳性预测值为0.96 (95%Cl 0.86-0.99)，阴性预测值为0.84（0.70-0.93）。讨论：在一些CFS和PBC患者中，自主神经功能障碍与疲劳密切相关，但不是全部。我们假设存在一个“交叉”的病因学过程的自主神经异常相关疲劳（DAF）。COMPASS >32.5是CFS和PBC自主神经功能障碍的有效诊断标准，可用于识别患者进行针对性干预研究。
Background: Chronic fatigue syndrome (CFS) is common and its cause is unknown. Aim: To study the prevalence of autonomic dysfunction in CFS, and to develop diagnostic criteria. Design: Cross-sectional study with independent derivation and validation phases. Methods: Symptoms of autonomic dysfunction were assessed using the Composite Autonomic Symptom Scale (COMPASS). Fatigue was assessed using the Fatigue Impact Scale (FIS). Subjects were studied in two groups: phase 1 (derivation phase), 40 CFS patients and 40 age- and sex-matched controls; phase 2 (validation phase), 30 CFS patients, 37 normal controls and 60 patients with primary biliary cirrhosis. Results: Symptoms of autonomic dysfunction were strongly and reproducibly associated with the presence of CFS or primary biliary cirrhosis (PBC), and correlated with severity of fatigue. Total COMPASS score > 32.5 was identified in phase I as a diagnostic criterion for autonomic dysfunction in CFS patients, and was shown in phase 2 to have a positive predictive value of 0.96 (95%Cl 0.86-0.99) and a negative predictive value of 0.84 (0.70-0.93) for the diagnosis of CFS. Discussion: Autonomic dysfunction is strongly associated with fatigue in some, but not all, CFS and PBC patients. We postulate the existence of a 'cross-cutting' aetiological process of dysautonomia-associated fatigue (DAF). COMPASS >32.5 is a valid diagnostic criterion for autonomic dysfunction in CFS and PBC, and can be used to identify patients for targeted intervention studies.