Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Following Infectious Mononucleosis.
Predictors for Developing Severe Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Following Infectious Mononucleosis.
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DOI：
10.29245/2767-5122/2021/1.1129
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发表时间：
2022
期刊：
影响因子：
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通讯作者：
Katz BZ
中科院分区：
文献类型：
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作者：
Jason LA;Cotler J;Islam MF;Furst J;Katz BZ
大约 10% 的传染性单核细胞增多症 (IM) 患者在 6 个月后出现符合肌痛性脑脊髓炎/慢性疲劳综合征 (ME/CFS) 标准的症状。我们的研究首次检验了是否可以预测谁会在 IM 后患上 ME/CFS。我们报告了一个由 4,501 名大学生组成的前瞻性队列，其中 238 名（5.3%）患有 IM。那些发生 IM 的患者在六个月后进行了随访，以确定他们是否康复或符合 ME/CFS 标准。本研究重点关注 48 名在六个月后被诊断为 ME/CFS 的学生，以及由 58 名 IM 后没有进一步症状的学生组成的匹配对照组。所有这 106 名学生都拥有在经历 IM 时和 IM 后 6 个月的基线数据（至少在 IM 发展之前 6 周）。在 IM 未恢复的患者中，分为两组：30 人被归类为 ME/CFS，18 人被归类为严重 ME/CFS。我们测量了 7 份问卷的结果、体检结果、单核细胞增多症的严重程度以及基线（病前）和 IM 时的细胞因子分析。我们检查了 IM 后出现 ME/CFS 和严重 ME/CFS 患者的预测因子（例如，病前变量以及 IM 发作时的变量）。根据接收者操作特征统计数据的分析，基线时有胃痛、腹胀和肠易激等严重胃肠道症状，基线时免疫标记物 IL-13 和/或 IL-5 水平异常低，以及感染 IM 时出现严重胃肠道症状的学生，在 IM 后六个月内出现严重 ME/CFS 的可能性接近 80%。我们的研究结果与新兴文献一致，即胃肠道不适和自主神经症状以及多种免疫标志物可能与严重 ME/CFS 的发展有关。
About 10% of individuals who contract infectious mononucleosis (IM) have symptoms 6 months later that meet criteria for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Our study for the first time examined whether it is possible to predict who will develop ME/CFS following IM. We have reported on a prospectively recruited cohort of 4,501 college students, of which 238 (5.3%) developed IM. Those who developed IM were followed-up at six months to determine whether they recovered or met criteria for ME/CFS. The present study focuses on 48 students who after six months had a diagnosis of ME/CFS, and a matched control group of 58 students who had no further symptoms after their IM. All of these 106 students had data at baseline (at least 6 weeks prior to the development of IM), when experiencing IM, and 6 months following IM. Of those who did not recover from IM, there were two groups: 30 were classified as ME/CFS and 18 were classified as severe ME/CFS. We measured the results of 7 questionnaires, physical examination findings, the severity of mononucleosis and cytokine analyses at baseline (pre-illness) and at the time of IM. We examined predictors (e.g., pre-illness variables as well as variables at onset of IM) of those who developed ME/CFS and severe ME/CFS following IM. From analyses using receiver operating characteristic statistics, the students who had had severe gastrointestinal symptoms of stomach pain, bloating, and an irritable bowel at baseline and who also had abnormally low levels of the immune markers IL-13 and/or IL-5 at baseline, as well as severe gastrointestinal symptoms when then contracted IM, were found to have a nearly 80% chance of having severe ME/CFS persisting six months following IM. Our findings are consistent with emerging literature that gastrointestinal distress and autonomic symptoms, along with several immune markers, may be implicated in the development of severe ME/CFS.