Centre for Child & Adolescent Health, School of Social & Community Medicine, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.
QJM. 2013 Jun;106(6):555-65. doi: 10.1093/qjmed/hct061. Epub 2013 Mar 28.
Chronic fatigue syndrome (CFS) is relatively common and disabling. Over 8000 patients attend adult services each year, yet little is known about the outcome of patients attending NHS services.
Investigate the outcome of patients with CFS and what factors predict outcome.
Longitudinal patient cohort.
We used data from six CFS/ME (myalgic encephalomyelitis) specialist services to measure changes in fatigue (Chalder Fatigue Scale), physical function (SF-36), anxiety and depression (Hospital Anxiety and Depression Scale) and pain (visual analogue pain rating scale) between clinical assessment and 8-20 months of follow-up. We used multivariable linear regression to investigate baseline factors associated with outcomes at follow-up.
Baseline data obtained at clinical assessment were available for 1643 patients, of whom 834 (51%) had complete follow-up data. There were improvements in fatigue [mean difference from assessment to outcome: -6.8; 95% confidence interval (CI) -7.4 to -6.2; P < 0.001]; physical function (4.4; 95% CI 3.0-5.8; P < 0.001), anxiety (-0.6; 95% CI -0.9 to -0.3; P < 0.001), depression (-1.6; 95% CI -1.9 to -1.4; P < 0.001) and pain (-5.3; 95% CI -7.0 to -3.6; P < 0.001). Worse fatigue, physical function and pain at clinical assessment predicted a worse outcome for fatigue at follow-up. Older age, increased pain and physical function at assessment were associated with poorer physical function at follow-up.
Patients who attend NHS specialist CFS/ME services can expect similar improvements in fatigue, anxiety and depression to participants receiving cognitive behavioural therapy and graded exercise therapy in a recent trial, but are likely to experience less improvement in physical function. Outcomes were predicted by fatigue, disability and pain at assessment.
慢性疲劳综合征（CFS）较为常见且会导致残疾。每年有超过 8000 名患者在成人服务机构就诊，但人们对在国民保健制度（NHS）服务机构就诊的患者的结局知之甚少。
调查 CFS 患者的结局以及哪些因素可预测结局。
纵向患者队列。
我们使用来自六个 CFS/ME（肌痛性脑脊髓炎）专科服务的数据，在临床评估和 8-20 个月的随访期间，测量疲劳（Chalder 疲劳量表）、身体功能（SF-36）、焦虑和抑郁（医院焦虑和抑郁量表）以及疼痛（视觉模拟疼痛评分量表）的变化。我们使用多变量线性回归来调查与随访结局相关的基线因素。
在临床评估时获得了 1643 名患者的基线数据，其中 834 名（51%）患者有完整的随访数据。患者的疲劳感得到改善[从评估到结局的平均差异：-6.8；95%置信区间（CI）为-7.4 至-6.2；P<0.001]；身体功能（4.4；95%CI 为 3.0-5.8；P<0.001）、焦虑（-0.6；95%CI 为-0.9 至-0.3；P<0.001）、抑郁（-1.6；95%CI 为-1.9 至-1.4；P<0.001）和疼痛（-5.3；95%CI 为-7.0 至-3.6；P<0.001）。临床评估时更严重的疲劳、身体功能和疼痛预示着随访时疲劳感更差。评估时年龄更大、疼痛和身体功能增加与随访时身体功能更差相关。
在 NHS 专科 CFS/ME 服务机构就诊的患者可能会像参加最近一项试验的接受认知行为疗法和分级运动疗法的患者一样，经历类似的疲劳、焦虑和抑郁改善，但身体功能的改善可能较少。结局由评估时的疲劳、残疾和疼痛预测。
