Hemodynamics during the 10-minute NASA Lean Test: evidence of circulatory decompensation in a subset of ME/CFS patients
Hemodynamics during the 10-minute NASA Lean Test: evidence of circulatory decompensation in a subset of ME/CFS patients
复制标题
DOI：
10.1186/s12967-020-02481-y
复制
发表时间：
2020-08-15
影响因子：
7.4
通讯作者：
Bateman, Lucinda
中科院分区：
文献类型：
--
作者：
Lee, Jihyun;Vernon, Suzanne D.;Bateman, Lucinda
背景头晕、疲劳、虚弱、心悸、认知功能障碍、肌肉疼痛和运动不耐受是立位不耐受（OI）的一些症状。ME/CFS（肌痛性脑脊髓炎/慢性疲劳综合征）中存在大量OI共病。10分钟的NASA精益测试（NLT）是一种简单的护理点方法，可以帮助ME/CFS诊断并指导OI的管理和治疗。本研究的目的是了解ME/CFS患者在10分钟NLT期间发生的血流动力学变化。方法150例ME/CFS患者和75例年龄、性别、种族相匹配的健康对照者（HC）。我们招募了75名ME/CFS患者，他们患病时间少于4年（< 4 ME/CFS），75名ME/CFS患者患病时间超过10年（> 10 ME/CFS）。10分钟的NLT包括仰卧休息时测量血压和心率，以及每分钟测量一次，持续10分钟，同时肩胛骨靠墙站立，保持放松的姿势。在测试期间记录自发报告的症状。方差分析和回归分析用于检验组间血流动力学、症状和直立活动的差异和关系。结果10 min NLT至少需要5 min才能检测到血流动力学变化。与> 10 ME/CFS和HC相比，< 4 ME/CFS组具有显著更高的心率和异常变窄的脉压。与> 10 ME/CFS和HC相比，< 4 ME/CFS组经历了显著更多的OI症状。在< 4 ME/CFS组中观察到的循环失代偿与年龄或药物使用无关。结论ME/CFS患者亚组中存在以心率加快和脉压异常狭窄为特征的循环失代偿，其患病时间< 4年。这表明低静脉压引起的心室充盈不足。10分钟NLT可用于诊断和治疗新发现的ME/CFS患者亚组的循环失代偿。> 10 ME/CFS组在NLT期间的血流动力学变化不太明显，可能是由于随着时间的推移发生的适应和补偿。10分钟NLT是一种简单且临床上有用的床旁检测方法，可用于ME/CFS的早期诊断，并有助于指导OI治疗。
Background Lightheadedness, fatigue, weakness, heart palpitations, cognitive dysfunction, muscle pain, and exercise intolerance are some of the symptoms of orthostatic intolerance (OI). There is substantial comorbidity of OI in ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome). The 10-minute NASA Lean Test (NLT) is a simple, point-of-care method that can aid ME/CFS diagnosis and guide management and treatment of OI. The objective of this study was to understand the hemodynamic changes that occur in ME/CFS patients during the 10-minute NLT. Methods A total of 150 ME/CFS patients and 75 age, gender and race matched healthy controls (HCs) were enrolled. We recruited 75 ME/CFS patients who had been sick for less than 4 years (< 4 ME/CFS) and 75 ME/CFS patients sick for more than 10 years (> 10 ME/CFS). The 10-minute NLT involves measurement of blood pressure and heart rate while resting supine and every minute for 10 min while standing with shoulder-blades on the wall for a relaxed stance. Spontaneously reported symptoms are recorded during the test. ANOVA and regression analysis were used to test for differences and relationships in hemodynamics, symptoms and upright activity between groups. Results At least 5 min of the 10-minute NLT were required to detect hemodynamic changes. The < 4 ME/CFS group had significantly higher heart rate and abnormally narrowed pulse pressure compared to > 10 ME/CFS and HCs. The < 4 ME/CFS group experienced significantly more OI symptoms compared to > 10 ME/CFS and HCs. The circulatory decompensation observed in the < 4 ME/CFS group was not related to age or medication use. Conclusions Circulatory decompensation characterized by increased heart rate and abnormally narrow pulse pressure was identified in a subgroup of ME/CFS patients who have been sick for < 4 years. This suggests inadequate ventricular filling from low venous pressure. The 10-minute NLT can be used to diagnose and treat the circulatory decompensation in this newly recognized subgroup of ME/CFS patients. The > 10 ME/CFS group had less pronounced hemodynamic changes during the NLT possibly from adaptation and compensation that occurs over time. The 10-minute NLT is a simple and clinically useful point-of-care method that can be used for early diagnosis of ME/CFS and help guide OI treatment.