Vanderbilt Autonomic Dysfunction Center, Vanderbilt University School of Medicine, Nashville, TN, U.S.A.
Clin Sci (Lond). 2012 Feb;122(4):183-92. doi: 10.1042/CS20110200.
Several studies recognized an overlap between CFS (chronic fatigue syndrome) and POTS (postural tachycardia syndrome). We compared the autonomic and neurohormonal phenotype of POTS patients with CFS (CFS-POTS) to those without CFS (non-CFS-POTS), to determine whether CFS-POTS represents a unique clinical entity with a distinct pathophysiology. We recruited 58 patients with POTS, of which 47 were eligible to participate. A total of 93% of them reported severe fatigue [CIS (Checklist of Individual Strength), fatigue subscale >36], and 64% (n=30) fulfilled criteria for CFS (CFS-POTS). The prevalence of CFS symptoms (Centers for Disease Control and Prevention criteria) was greater in the CFS-POTS group, but the pattern of symptoms was similar in both groups. Physical functioning was low in both groups (RAND-36 Health Survey, 40±4 compared with 33±3; P=0.153), despite more severe fatigue in CFS-POTS patients (CIS fatigue subscale 51±1 compared with 43±3; P=0.016). CFS-POTS patients had greater orthostatic tachycardia than the non-CFS-POTS group (51±3 compared with 40±4 beats/min; P=0.030), greater low-frequency variability of BP (blood pressure; 6.3±0.7 compared with 4.8±1.0 mmHg2; P=0.019), greater BP recovery from early to late phase II of the Valsalva manoeuvre (18±3 compared with 11±2 mmHg; P=0.041) and a higher supine (1.5±0.2 compared with 1.0±0.3 ng/ml per·h; P=0.033) and upright (5.4±0.6 compared with 3.5±0.8 ng/ml per h; P=0.032) PRA (plasma renin activity). In conclusion, fatigue and CFS-defining symptoms are common in POTS patients. The majority of them met criteria for CFS. CFS-POTS patients have higher markers of sympathetic activation, but are part of the spectrum of POTS. Targeting this sympathetic activation should be considered in the treatment of these patients.
几项研究发现慢性疲劳综合征（CFS）和体位性心动过速综合征（POTS）之间存在重叠。我们比较了伴有 CFS（CFS-POTS）和不伴有 CFS（非 CFS-POTS）的 POTS 患者的自主神经和神经激素表型，以确定 CFS-POTS 是否代表一种具有独特病理生理学的独特临床实体。我们招募了 58 名 POTS 患者，其中 47 名符合参与条件。他们中有 93%（n=44）报告严重疲劳[CIS（个体力量检查表），疲劳子量表>36]，64%（n=30）符合 CFS 标准（CFS-POTS）。CFS-POTS 组的 CFS 症状（疾病控制和预防中心标准）患病率更高，但两组的症状模式相似。两组的身体机能都较低（RAND-36 健康调查，40±4 与 33±3；P=0.153），尽管 CFS-POTS 患者的疲劳更严重（CIS 疲劳子量表 51±1 与 43±3；P=0.016）。与非 CFS-POTS 组相比，CFS-POTS 患者的直立性心动过速更大（51±3 与 40±4 次/分；P=0.030），血压的低频变异性更大（BP；6.3±0.7 与 4.8±1.0 mmHg2；P=0.019），瓦尔萨尔瓦动作的早期到晚期 II 期的 BP 恢复更大（18±3 与 11±2 mmHg；P=0.041），卧位（1.5±0.2 与 1.0±0.3 ng/ml per·h；P=0.033）和站立位（5.4±0.6 与 3.5±0.8 ng/ml per h；P=0.032）PRA（血浆肾素活性）更高。总之，疲劳和 CFS 定义的症状在 POTS 患者中很常见。他们中的大多数符合 CFS 的标准。CFS-POTS 患者有更高的交感神经激活标志物，但属于 POTS 的范围。在治疗这些患者时，应考虑针对这种交感神经激活进行治疗。
