Reeves William C, Lloyd Andrew, Vernon Suzanne D, Klimas Nancy, Jason Leonard A, Bleijenberg Gijs, Evengard Birgitta, White Peter D, Nisenbaum Rosane, Unger Elizabeth R
Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America.
BMC Health Serv Res. 2003 Dec 31;3(1):25. doi: 10.1186/1472-6963-3-25.
Chronic fatigue syndrome (CFS) is defined by symptoms and disability, has no confirmatory physical signs or characteristic laboratory abnormalities, and the etiology and pathophysiology remain unknown. Difficulties with accurate case ascertainment contribute to this ignorance.
Experienced investigators from around the world who are involved in CFS research met for a series of three day workshops in 2000, 2001 and 2002 intended to identify the problems in application of the current CFS case definition. The investigators were divided into focus groups and each group was charged with a topic. The investigators in each focus group relied on their own clinical and scientific knowledge, brainstorming within each group and with all investigators when focus group summaries were presented. Relevant literature was selected and reviewed independent of the workshops. The relevant literature was circulated via list-serves and resolved as being relevant by group consensus. Focus group reports were analyzed and compiled into the recommendations presented here.
Ambiguities in the current CFS research definition that contribute to inconsistent case identification were identified. Recommendations for use of the definition, standardization of classification instruments and study design issues are presented that are intended to improve the precision of case ascertainment. The International CFS Study Group also identified ambiguities associated with exclusionary and comorbid conditions and reviewed the standardized, internationally applicable instruments used to measure symptoms, fatigue intensity and associated disability.
This paper provides an approach to guide systematic, and hopefully reproducible, application of the current case definition, so that case ascertainment would be more uniform across sites. Ultimately, an operational CFS case definition will need to be based on empirical studies designed to delineate the possibly distinct biological pathways that result in chronic fatigue.
慢性疲劳综合征（CFS）由症状和功能障碍定义，没有确诊的体征或特征性实验室异常，其病因和病理生理学仍不清楚。准确病例确诊的困难导致了这种认知不足。
来自世界各地参与CFS研究的经验丰富的研究人员于2000年、2001年和2002年参加了一系列为期三天的研讨会，旨在确定当前CFS病例定义应用中的问题。研究人员被分成焦点小组，每个小组负责一个主题。每个焦点小组的研究人员依靠自己的临床和科学知识，在小组内部以及在焦点小组总结报告时与所有研究人员一起进行头脑风暴。独立于研讨会选择并审查相关文献。通过邮件列表分发相关文献，并经小组共识确定为相关文献。对焦点小组报告进行分析并汇编成本文提出的建议。
确定了当前CFS研究定义中导致病例识别不一致的模糊之处。提出了关于定义使用、分类工具标准化和研究设计问题的建议，旨在提高病例确诊的准确性。国际CFS研究小组还确定了与排除标准和共病情况相关的模糊之处，并审查了用于测量症状、疲劳强度和相关功能障碍的标准化、国际适用工具。
本文提供了一种方法，以指导系统且有望可重复地应用当前病例定义，从而使各研究地点的病例确诊更加统一。最终，实用的CFS病例定义需要基于旨在描绘导致慢性疲劳的可能不同生物学途径的实证研究。
