McCauley L A, Joos S K, Lasarev M R, Storzbach D, Bourdette D N
Center for Research on Occupational and Environmental Toxicology, Oregon Health Sciences University, Portland 97201-3098, USA.
Environ Res. 1999 Oct;81(3):215-23. doi: 10.1006/enrs.1999.3973.
Most published reports of health symptoms among Gulf War (GW) veterans have been based on self-reported questionnaire data. The presence of these symptoms at the time of a clinical evaluation and the unexplained nature of the symptoms have not been described. We report the findings of a sample of symptomatic veterans that were examined as part of a population-based case-control study of GW unexplained illnesses. Participants in the case-control study were selected from responders to a cross-sectional survey of a random sample of GW veterans residing in the northwestern United States. The initial survey questionnaire solicited information on the presence of fatigue and psychological/cognitive, gastrointestinal, musculoskeletal, and dermatological problems. The persistence of the symptoms and possible explanatory diagnoses were explored at the time of the clinical evaluation. Findings from the first 225 participants who completed clinical examinations indicate significant differences between self-reported symptoms on the survey questionnaire and those confirmed at the time of clinical exam. The agreement between symptoms reported both on the survey and at the time of examination varies across the symptom groups. While self-reported unexplained fatigue was confirmed at the time of clinical encounter in 79% of participants, self-reported gastrointestinal symptoms were confirmed at the clinical encounter in only 20% of participants. Differences between symptoms reported on the survey questionnaire and those confirmed at the time of clinical encounter were attributable to finding a clinical diagnosis for the symptom, resolution of symptom(s) between time of questionnaire and clinical exam, and inadvertent endorsement of the symptom on the questionnaire. These findings suggest that due to the possibility of outcome misclassification, inappropriate conclusions may be drawn about the association between exposures and unexplained illnesses in GW veterans from data derived solely from self-administered questionnaires.
大多数关于海湾战争（GW）退伍军人健康症状的已发表报告都基于自我报告的问卷调查数据。这些症状在临床评估时的存在情况以及症状的无法解释性尚未得到描述。我们报告了一组有症状退伍军人的研究结果，这些退伍军人是作为一项基于人群的GW无法解释疾病病例对照研究的一部分接受检查的。病例对照研究的参与者是从居住在美国西北部的GW退伍军人随机样本的横断面调查的应答者中选取的。初始调查问卷征集了关于疲劳以及心理/认知、胃肠道、肌肉骨骼和皮肤问题存在情况的信息。在临床评估时探讨了症状的持续性以及可能的解释性诊断。前225名完成临床检查的参与者的研究结果表明，调查问卷上自我报告的症状与临床检查时确认的症状之间存在显著差异。调查和检查时报告的症状之间的一致性在不同症状组中有所不同。虽然在临床会诊时79%的参与者自我报告的无法解释的疲劳得到了确认，但自我报告的胃肠道症状在临床会诊时只有20%的参与者得到了确认。调查问卷上报告的症状与临床会诊时确认的症状之间的差异可归因于为症状找到临床诊断、在问卷调查和临床检查之间症状的缓解以及在调查问卷上无意认可该症状。这些发现表明，由于存在结果错误分类的可能性，仅从自我填写的调查问卷得出的数据可能会就GW退伍军人中暴露与无法解释疾病之间的关联得出不恰当的结论。
