ME-de-Patiënten Foundation Limmen, Netherlands.
Front Physiol. 2014 Mar 27;5:109. doi: 10.3389/fphys.2014.00109. eCollection 2014.
Although Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS) are used interchangeably, the diagnostic criteria define two distinct clinical entities. Cognitive impairment, (muscle) weakness, circulatory disturbances, marked variability of symptoms, and, above all, post-exertional malaise: a long-lasting increase of symptoms after a minor exertion, are distinctive symptoms of ME. This latter phenomenon separates ME, a neuro-immune illness, from chronic fatigue (syndrome), other disorders and deconditioning. The introduction of the label, but more importantly the diagnostic criteria for CFS have generated much confusion, mostly because chronic fatigue is a subjective and ambiguous notion. CFS was redefined in 1994 into unexplained (persistent or relapsing) chronic fatigue, accompanied by at least four out of eight symptoms, e.g., headaches and unrefreshing sleep. Most of the research into ME and/or CFS in the last decades was based upon the multivalent CFS criteria, which define a heterogeneous patient group. Due to the fact that fatigue and other symptoms are non-discriminative, subjective experiences, research has been hampered. Various authors have questioned the physiological nature of the symptoms and qualified ME/CFS as somatization. However, various typical symptoms can be assessed objectively using standardized methods. Despite subjective and unclear criteria and measures, research has observed specific abnormalities in ME/CFS repetitively, e.g., immunological abnormalities, oxidative and nitrosative stress, neurological anomalies, circulatory deficits and mitochondrial dysfunction. However, to improve future research standards and patient care, it is crucial that patients with post-exertional malaise (ME) and patients without this odd phenomenon are acknowledged as separate clinical entities that the diagnosis of ME and CFS in research and clinical practice is based upon accurate criteria and an objective assessment of characteristic symptoms, as much as possible that well-defined clinical and biological subgroups of ME and CFS patients are investigated in more detail, and that patients are monitored before, during and after interventions with objective measures and biomarkers.
虽然肌痛性脑脊髓炎 (ME) 和慢性疲劳综合征 (CFS) 可互换使用，但诊断标准定义了两种不同的临床实体。认知障碍、（肌肉）无力、循环障碍、症状的明显波动性，尤其是劳累后不适：轻微劳累后症状持续长时间增加，这些都是 ME 的独特症状。这种现象将 ME（一种神经免疫疾病）与慢性疲劳（综合征）、其他疾病和身体不适区分开来。标签的引入，更重要的是 CFS 的诊断标准，引起了很多混淆，主要是因为慢性疲劳是一个主观和模糊的概念。1994 年，CFS 被重新定义为无法解释的（持续性或复发性）慢性疲劳，伴有至少八项症状中的四项，例如头痛和睡眠不足。过去几十年对 ME 和/或 CFS 的大部分研究都是基于多价 CFS 标准，该标准定义了一个异质的患者群体。由于疲劳和其他症状是非歧视性的、主观的体验，研究受到了阻碍。许多作者对症状的生理性质提出了质疑，并将 ME/CFS 定性为躯体化。然而，使用标准化方法可以客观评估各种典型症状。尽管存在主观和不明确的标准和措施，但研究已经反复观察到 ME/CFS 中的特定异常，例如免疫异常、氧化和硝化应激、神经异常、循环缺陷和线粒体功能障碍。然而，为了提高未来的研究标准和患者护理水平，至关重要的是，将出现劳累后不适（ME）的患者和没有这种异常现象的患者确认为独立的临床实体，ME 和 CFS 的诊断应基于准确的标准和对特征性症状的客观评估，尽可能地将 ME 和 CFS 患者的明确临床和生物学亚组进行更详细的研究，并使用客观测量和生物标志物在干预前、干预中和干预后对患者进行监测。
