Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.
Neurohumoral and haemodynamic profile in postural tachycardia and chronic fatigue syndromes.
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DOI：
10.1042/cs20110200
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发表时间：
2012-02
期刊：
影响因子：
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通讯作者：
Biaggioni I
中科院分区：
文献类型：
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作者：
Okamoto LE;Raj SR;Peltier A;Gamboa A;Shibao C;Diedrich A;Black BK;Robertson D;Biaggioni I
一些研究发现CFS(慢性疲劳综合征)和POTS(体位性心动过速综合征)之间存在重叠。我们比较了有CFS的POTS患者(CFS-POTS)和无CFS的POTS患者(Non-CFS-POTS)的自主神经和神经激素表型，以确定CFS-POTS是否代表了具有不同病理生理特征的独特临床实体。我们招募了58名POTS患者，其中47人符合参与条件。共有93%的受试者报告严重疲劳[CIS(个人力量量表)、疲劳子量表(36)]和(n=30)达到CFS(CFS-POTS)标准。CFS-POTS组的CFS症状(疾病控制和预防中心标准)的患病率更高，但两组的症状模式相似。两组患者的身体功能均较差(RAND-36健康调查，40±4分比33±3分；P=0.153)，但CFS-POTS患者的疲劳程度更严重(CIS疲劳分51±1分比43±3分；P=0.016)。CFS-POTS患者较非CFS-POTS患者有更大的立位性心动过速(51±3比40±4次/分；P=0.030)，更大的血压低频变异性(血压6.3±0.7比4.8±1.0mmHg2；P=0.019)，更高的血压恢复(18±3比11±2毫米汞柱；P=0.041)和更高的仰卧位(1.5±0.2比1.0±0.3 ng/ml/h)；P=0.033)和立位(5.40±0.6vs3.5±0.8ng.h；P=0.032)(血浆肾素活性)。总而言之，疲劳和定义CFS的症状在POTS患者中很常见。他们中的大多数符合CFS的标准。CFS-POTS患者具有较高的交感神经激活标志物，但也是POTS谱的一部分。在这些患者的治疗中，应该考虑针对这种交感神经的激活。
Several studies recognized an overlap between CFS (chronic fatigue syndrome) and POTS (postural tachycardia syndrome). We compared the autonomic and neurohormonal phenotype of POTS patients with CFS (CFS–POTS) to those without CFS (non-CFS–POTS), to determine whether CFS–POTS represents a unique clinical entity with a distinct pathophysiology. We recruited 58 patients with POTS, of which 47 were eligible to participate. A total of 93% of them reported severe fatigue [CIS (Checklist of Individual Strength), fatigue subscale >36], and 64% (n=30) fulfilled criteria for CFS (CFS–POTS). The prevalence of CFS symptoms (Centers for Disease Control and Prevention criteria) was greater in the CFS–POTS group, but the pattern of symptoms was similar in both groups. Physical functioning was low in both groups (RAND-36 Health Survey, 40±4 compared with 33±3; P=0.153), despite more severe fatigue in CFS–POTS patients (CIS fatigue subscale 51±1 compared with 43±3; P=0.016). CFS–POTS patients had greater orthostatic tachycardia than the non-CFS–POTS group (51±3 compared with 40±4 beats/min; P=0.030), greater low-frequency variability of BP (blood pressure; 6.3±0.7 compared with 4.8±1.0 mmHg2; P=0.019), greater BP recovery from early to late phase II of the Valsalva manoeuvre (18±3 compared with 11±2 mmHg; P=0.041) and a higher supine (1.5±0.2 compared with 1.0±0.3 ng/ml per·h; P=0.033) and upright (5.4±0.6 compared with 3.5±0.8 ng/ml per h; P=0.032) PRA (plasma renin activity). In conclusion, fatigue and CFS-defining symptoms are common in POTS patients. The majority of them met criteria for CFS. CFS–POTS patients have higher markers of sympathetic activation, but are part of the spectrum of POTS. Targeting this sympathetic activation should be considered in the treatment of these patients.