Appel Shmuel, Chapman Joab, Shoenfeld Yehuda
Department of Neurology, Sheba Medical Center, Tel Hashomer, Israel.
Autoimmunity. 2007 Feb;40(1):48-53. doi: 10.1080/08916930701197273.
Chronic fatigue syndrome (CFS) is characterized by severe disabling fatigue lasting for more than 6 months associated with physical and mental disturbances such as headache, arthralgia, myalgia, memory impairment, sore throat and tender lymph nodes. The exact pathogenesis is still unknown. Several models were proposed to explain its etiology including chronic infection, endocrine dysfunction, autonomic imbalance, depression, decreased immunity states and an aberrant reaction to infection. No convincing evidence was found to support any of the suggested pathogenic mechanisms. The current concept is that CFS pathogenesis is a multi factorial condition in which an infective agent cause an aberrant immune response characterized by a shift to Th-2 dominant response. When the response fails to be switched-off, a chronic immune activation occurs and clinically expressed as the symptomatology of CFS. Vaccinations are used in order to stimulate the immune system to induce a persistent immunity against the favorable antigens. Several syndromes that contain chronic fatigue as one of their symptoms, such as "Gulf war syndrome" and macrophagic myofasciitis were related to vaccinations. Can vaccinations induce the aberrant immune response of CFS? Little is known about this issue. There are some reports on CFS occurring after vaccination, but few prospective and retrospective studies failed to find such an association. A working group of the Canadian Laboratory Center for Disease Control (LCDC) that was founded in order to examine the suspected association between CFS and vaccinations concluded that there is no evidence that relates CFS to vaccination. Further studies are requested to examine this issue since it is very conceivable that if infection can lead to CFS, vaccination may also lead to it in the same immune-mediated pathogenesis.
慢性疲劳综合征（CFS）的特征是严重的致残性疲劳持续超过6个月，并伴有身体和精神方面的不适，如头痛、关节痛、肌痛、记忆障碍、喉咙痛和淋巴结压痛。确切的发病机制仍然未知。人们提出了几种模型来解释其病因，包括慢性感染、内分泌功能障碍、自主神经失调、抑郁、免疫状态下降以及对感染的异常反应。但没有找到令人信服的证据来支持任何一种所提出的致病机制。目前的观点是，CFS的发病机制是一种多因素状况，其中感染因子引发异常的免疫反应，其特征是向Th-2主导反应转变。当这种反应未能被关闭时，就会发生慢性免疫激活，并在临床上表现为CFS的症状。接种疫苗是为了刺激免疫系统以诱导对有益抗原的持久免疫力。一些以慢性疲劳为症状之一的综合征，如“海湾战争综合征”和巨噬细胞性肌筋膜炎，都与接种疫苗有关。接种疫苗会诱发CFS的异常免疫反应吗？关于这个问题知之甚少。有一些关于接种疫苗后发生CFS的报道，但很少有前瞻性和回顾性研究发现这种关联。加拿大疾病控制实验室中心（LCDC）成立了一个工作组来研究CFS与接种疫苗之间的可疑关联，该工作组得出结论，没有证据表明CFS与接种疫苗有关。由于很有可能如果感染会导致CFS，那么在相同的免疫介导发病机制下接种疫苗也可能导致CFS，因此需要进一步研究来探讨这个问题。
