Hotopf M, David A, Hull L, Nikalaou V, Unwin C, Wessely S
Gulf War Illness Research Unit, Guy's King's and St Thomas' School of Medicine, King's College, London.
Psychol Med. 2004 May;34(4):747-54. doi: 10.1017/S0033291703001016.
There are no prospective cohort studies of prognostic factors on the outcome of Gulf War veterans. We aimed to test the hypotheses that Gulf War veterans who were older; had more severe symptoms; had more exposures during deployment; had increased psychological distress and believed they had 'Gulf War syndrome' would experience greater fatigue and poorer physical functioning at follow-up.
Gulf War veterans who responded to an earlier retrospective cohort study were followed with a postal survey. More symptomatic individuals were oversampled. Outcome was measured on the Chalder fatigue questionnaire, the General Health Questionnaire and the Medical Outcome Study Short-Form 36.
Of those surveyed, 73.8% responded. We found some evidence for four of the five hypotheses. More self-reported exposures at baseline were not associated with poorer outcome, but older people, those with more severe symptoms at baseline, those with psychological distress and who believed they were suffering from 'Gulf War syndrome' had more fatigue at follow-up. Officer status was associated with a better outcome. A similar lack of association was found for exposures and physical functioning and GHQ-12 score. 'Gulf War syndrome' attribution was associated with a worse outcome for GHQ-12 and physical functioning even after controlling for severity of symptoms at baseline.
This study suggests that while multiple vaccination and military exposures are important risk factors for the onset of symptoms in Gulf War veterans, these are not important risk factors for persistence of such symptoms. Instead the severity of the initial symptoms; psychological distress and attributions may be more important determinants of outcome.
目前尚无关于海湾战争退伍军人预后因素的前瞻性队列研究。我们旨在检验以下假设：年龄较大、症状较严重、在部署期间接触更多、心理困扰增加且认为自己患有“海湾战争综合征”的海湾战争退伍军人，在随访时会出现更严重的疲劳和更差的身体功能。
对早期回顾性队列研究的应答者进行邮政调查随访。对症状较多的个体进行过度抽样。通过查尔德疲劳问卷、一般健康问卷和医学结局研究简表36来测量结果。
在接受调查的人中，73.8%进行了回应。我们发现五个假设中的四个有一些证据支持。基线时自我报告的更多接触与较差的结局无关，但年龄较大者、基线时症状较严重者、有心理困扰者以及认为自己患有“海湾战争综合征”者在随访时疲劳更严重。军官身份与较好的结局相关。在接触与身体功能以及GHQ - 12评分方面也发现了类似的无关联系。即使在控制了基线症状严重程度之后，“海湾战争综合征”归因与GHQ - 12及身体功能的较差结局相关。
本研究表明，虽然多次接种疫苗和军事接触是海湾战争退伍军人症状发作的重要风险因素，但这些并非此类症状持续存在的重要风险因素。相反，初始症状的严重程度、心理困扰和归因可能是结局的更重要决定因素。
