青少年慢性疲劳综合征；一项随访研究显示循环异常和临床症状同时改善。
Adolescent chronic fatigue syndrome; a follow-up study displays concurrent improvement of circulatory abnormalities and clinical symptoms.
机构信息
Department of Paediatric Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
出版信息
Biopsychosoc Med. 2012 Mar 21;6:10. doi: 10.1186/1751-0759-6-10.
BACKGROUND
The pathophysiology of chronic fatigue syndrome (CFS) in adolescents is unknown, and the clinical course and prognosis is still questioned. Recent research indicates that abnormalities of autonomic cardiovascular control may play an important role. The aim of this research project was to perform a follow-up study of adolescents with chronic fatigue syndrome, focusing on clinical symptoms and autonomic cardiovascular control.
METHODS
47 adolescents (12-18 years old) with CFS were recruited from the outpatient clinic at the Department of Pediatrics, Oslo University Hospital. In a primary visit and a follow-up visit (3-17 months later), we evaluated: a) a wide range of complaints and symptoms and b) cardiovascular variables at baseline and during a 20° head-up tilt-test (HUT).
RESULTS
At the second visit, patients reported significant improvement regarding functional impairments, fatigue severity, muscular pain, concentration problems, post-exertional malaise and the problem of non-relieving rest. Also, at the second visit, baseline heart rate (HR), blood pressure, total peripheral resistance index (TPRI) and LF/HF (low-frequency:high-frequency heart rate variability ratio, an index of sinus node sympathovagal balance derived from spectral analyses of heart rate) were significant lower, and the increases in HR, mean blood pressure (MBP), diastolic blood pressure (DBP) and TPRI during tilt were significantly less pronounced as compared to the first visit. There was a significant correlation between changes in autonomic symptom score, fatigue severity score and functional impairment score from the first to the second visit.
CONCLUSIONS
The majority of adolescents with CFS experienced an improvement over time in functional impairment, self-reported fatigue and additional symptoms, and a concurrent improvement of autonomic cardiovascular control. A possible connection between clinical symptoms and abnormal autonomic control in CFS might represent a focus for further research.
背景
青少年慢性疲劳综合征（CFS）的病理生理学尚不清楚，其临床病程和预后仍存在疑问。最近的研究表明，自主心血管控制的异常可能起着重要作用。本研究项目的目的是对青少年慢性疲劳综合征患者进行随访研究，重点关注临床症状和自主心血管控制。
方法
从奥斯陆大学医院儿科门诊招募了 47 名（12-18 岁）慢性疲劳综合征青少年患者。在初次就诊和随访就诊（3-17 个月后）时，我们评估了：a）广泛的抱怨和症状，以及 b）基线和 20°头高位倾斜试验（HUT）期间的心血管变量。
结果
在第二次就诊时，患者报告在功能障碍、疲劳严重程度、肌肉疼痛、注意力问题、劳累后不适和无法缓解的休息问题方面有显著改善。此外，在第二次就诊时，静息心率（HR）、血压、总外周阻力指数（TPRI）和 LF/HF（低频：高频心率变异性比，一种源于心率谱分析的窦房结交感神经平衡指数）均显著降低，并且 HR、平均血压（MBP）、舒张压（DBP）和 TPRI 在倾斜时的增加也明显低于初次就诊。从初次就诊到第二次就诊，自主症状评分、疲劳严重程度评分和功能障碍评分的变化之间存在显著相关性。
结论
大多数青少年慢性疲劳综合征患者随着时间的推移，在功能障碍、自我报告的疲劳和其他症状方面都有改善，并且自主心血管控制也得到了改善。慢性疲劳综合征中临床症状与自主神经控制异常之间的可能联系可能代表进一步研究的重点。
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