Department of Psychiatry, Erciyes University Medical School, Kayseri, Turkey.
Psychiatry Investig. 2009 Sep;6(3):204-10. doi: 10.4306/pi.2009.6.3.204. Epub 2009 Jun 23.
Mental fatigue, cognitive disorders, and sleep disturbances seen in chronic fatigue syndrome (CFS) may be attributed to cholinergic deficit. A functional deficiency of cholinergic neurotransmission may cause the hypothalamic-pituitary-adrenal axis hypoactivity seen in CFS. Therefore, we investigated the alterations in stress hormones such as cortisol and dehydroepiandrosterone sulfate (DHEAS) in CFS patients before and after 4-week administration of galantamine hydrobromide, a selective acetylcholinesterase inhibitor, and aimed to investigate whether there are any relationships between the probable hormonal changes and cholinergic treatment.
Basal levels of cortisol and DHEAS were measured in 29 untreated CFS patients who were diagnosed according to Centers for Disease Control (CDC) criteria and in 20 healthy controls. In the patient group, four weeks after 8 mg/d galantamine hydrobromide treatment, cortisol and DHEAS levels were measured again. After the treatment 22 patients who stayed in study were divided into two subgroups as responders and nonresponders according to the reduction in their Newcastle Research Group ME/CFS Score Card (NRG) scores.
Important findings of this study are lower pre-and post-treatment cortisol levels and in all CFS patients compared to controls (F=4.129, p=0.049; F=4.803, p=0.035, respectively); higher basal DHEAS values and higher DHEAS/cortisol molar ratios which were normalized following four weeks' treatment with 8 mg/d galantamine hydrobromide in the treatment-respondent group (F=5.382, p=0.029; F=5.722, p=0.025, respectively).
The findings of the decrease in basal DHEAS levels and DHEAS/cortisol molar ratios normalizing with galantamine treatment may give some support to the cholinergic deficit hypothesis in CFS.
慢性疲劳综合征（CFS）中出现的精神疲劳、认知障碍和睡眠障碍可能归因于胆碱能缺乏。胆碱能神经传递的功能缺陷可能导致 CFS 中下丘脑-垂体-肾上腺轴的活性降低。因此，我们研究了在未经治疗的 29 例 CFS 患者和 20 例健康对照者中，在给予选择性乙酰胆碱酯酶抑制剂加兰他敏氢溴酸盐 4 周前后应激激素（如皮质醇和硫酸脱氢表雄酮（DHEAS））的变化，并旨在研究可能的激素变化与胆碱能治疗之间是否存在任何关系。
根据疾病控制中心（CDC）标准诊断的 29 例未经治疗的 CFS 患者和 20 例健康对照者的基础皮质醇和 DHEAS 水平进行了测量。在患者组中，在给予 8mg/d 加兰他敏氢溴酸盐治疗 4 周后，再次测量皮质醇和 DHEAS 水平。治疗后，根据其纽卡斯尔研究小组 ME/CFS 评分卡（NRG）评分的降低，将 22 例留在研究中的患者分为反应者和无反应者两组。
本研究的重要发现是，与对照组相比，所有 CFS 患者治疗前后的皮质醇水平均较低（F=4.129，p=0.049；F=4.803，p=0.035）；基础 DHEAS 值较高，且在治疗反应组中，给予 8mg/d 加兰他敏氢溴酸盐治疗 4 周后，DHEAS/皮质醇摩尔比值升高且正常化（F=5.382，p=0.029；F=5.722，p=0.025）。
基础 DHEAS 水平降低和 DHEAS/皮质醇摩尔比值正常化的发现可能为 CFS 中的胆碱能缺乏假说提供一些支持。
