To "lump" or to "split"' the functional somatic syndromes: Can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome?
To "lump" or to "split"' the functional somatic syndromes: Can infectious and emotional risk factors differentiate between the onset of chronic fatigue syndrome and irritable bowel syndrome?
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DOI：
10.1097/01.psy.0000221384.07521.05
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发表时间：
2006-05-01
影响因子：
3.3
通讯作者：
Spence, M
中科院分区：
文献类型：
--
作者：
Moss-Morris, R;Spence, M
目的：功能性躯体综合征应被定义为独立的实体还是一个综合征，是近年来学术界争论的焦点。本研究的目的是调查两种常见的功能性综合征，肠易激综合征（IBS）和慢性疲劳综合征（CFS）的病因或促发因素是否存在显著差异。我们前瞻性研究了592例急性弯曲杆菌胃肠炎和243例急性传染性单核细胞增多症患者，这些患者既往无CFS或IBS病史。在感染时，患者完成了一份基线问卷，使用医院焦虑和抑郁量表测量他们的痛苦程度。在3个月和6个月的随访中，他们完成了问卷调查，以确定他们是否符合慢性疲劳（CF），CFS和/或IBS的诊断标准。在3- 10岁时，弯曲杆菌感染后发生IBS的几率显著高于感染后单核细胞增多症。（比值比，3.45 [95%置信区间（CI），1.75-6.67]）和6-（2.22 [95% CI，1.11-6.67]）个月随访。相比之下，在感染后3个月（2.77 [95%CI，1.08-7.11]）而不是6个月（1.48 [95%CI，0.62-3.55]），感染性单核细胞增多症后发生CF/CFS的几率显著高于弯曲杆菌感染后。焦虑和抑郁是CF/CFS的最强预测因子，而感染的性质是最强的预测IBS.Conclusions：这些结果支持区分感染后IBS和CFS的论点。诱发感染的性质似乎很重要，发病前的痛苦水平似乎与CFS比IBS更密切相关。尤其是抑郁的程度。
Objectives: Recent academic debate has centered on whether functional somatic syndromes should be defined as separate entities or as one syndrome. The aim of this study was to investigate whether there may be significant differences in the etiology or precipitating factors associated with two common functional syndromes, irritable bowel syndrome (IBS) and chronic fatigue syndrome (CFS).Methods: We prospectively studied 592 patients with an acute episode of Campylobacter gastroenteritis and 243 with an acute episode of infectious mononucleosis who had no previous history of CFS or IBS. At the time of infection, patients completed a baseline questionnaire that measured their levels of distress using the Hospital Anxiety and Depression scale. At 3- and 6-month follow-up, they completed questionnaires to determine whether they met published diagnostic criteria for chronic fatigue (CF), CFS, and/or IBS.Results: The odds of developing IBS were significantly greater post-Campylobacter than post-infectious mononucleosis at both 3- (odds ratio, 3.45 [95% confidence interval (CI), 1.75-6.67]) and 6- (2.22 [95% CI, 1.11-6.67]) month follow-up. In contrast, the odds for developing CF/CFS were significantly greater after infectious mononucleosis than after Campylobacter at 3 (2.77 [95% CI, 1.08-7.11]) but not 6 (1.48 [95% CI, 0.62-3.55]) months postinfection. Anxiety and depression were the strongest predictors of CF/CFS, whereas the nature of the infection was the strongest predictor of IBS.Conclusions: These results support the argument to distinguish between postinfectious IBS and CFS. The nature of the precipitating infection appears to be important, and premorbid levels of distress appear to be more strongly associated with CFS than IBS. particularly levels of depression.