姿势性直立性心动过速不是慢性疲劳综合征的有用诊断标志物。

Postural orthostatic tachycardia is not a useful diagnostic marker for chronic fatigue syndrome.

机构信息

Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, the Netherlands.

Department of Internal Medicine III, University Hospital Carl Gustav Carus, Technical University of Dresden, Dresden, Germany.

出版信息

J Intern Med. 2017 Feb;281(2):179-188. doi: 10.1111/joim.12564. Epub 2016 Oct 2.

DOI:10.1111/joim.12564

PMID:27696568

Abstract

BACKGROUND

Postural orthostatic tachycardia syndrome (POTS) is considered a diagnostic marker for chronic fatigue syndrome (CFS).

OBJECTIVES

The aims of this study were to (i) compare POTS prevalence in a CFS cohort with fatigued patients not meeting CFS criteria, and (ii) assess activity, impairment and response to cognitive behavioural therapy (CBT) in CFS patients with POTS (POTS-CFS) and without POTS (non-POTS-CFS).

METHODS

Prospective cohort study at the Radboud University Medical Centre in the Netherlands. Between June 2013 and December 2014, 863 consecutive patients with persistent fatigue were screened. Patients underwent an active standing test, filled out questionnaires and wore an activity-sensing device for a period of 12 days.

RESULTS

A total of 419 patients with CFS and 341 non-CFS fatigued patients were included in the study. POTS prevalence in adult patients with CFS was 5.7% vs. 6.9% in non-CFS adults (P = 0.54). In adolescents, prevalence rates were 18.2% and 17.4%, respectively (P = 0.93). Adult patients with POTS-CFS were younger (30 ± 12 vs. 40 ± 13 years, P = 0.001) and had a higher supine heart rate (71 ± 11 vs. 65 ± 9 beats per min, P = 0.009) compared with non-POTS-CFS patients. Severity and activity patterns did not differ between groups. In patients with CFS, criteria for Systemic Exertion Intolerance Disease (SEID) were met in 76% of adults and 67% of adolescents. In these patients with CFS fulfilling the SEID criteria, the prevalence of POTS was not different from that in the overall CFS population. POTS-CFS adolescents had less clinically significant improvement after CBT than non-POTS-CFS adolescents (58% vs. 88%, P = 0.017).

CONCLUSION

In adults with CFS, the prevalence of POTS was low, was not different from the rate in non-CFS fatigued patients and was not related to disease severity or treatment outcome. In POTS-CFS adolescents, CBT was less successful than in non-POTS-CFS patients. The evaluation of POTS appears to be of limited value for the diagnosis of CFS.

摘要

背景

体位性心动过速综合征（POTS）被认为是慢性疲劳综合征（CFS）的诊断标志物。

目的

本研究旨在：（i）比较 CFS 队列中 POTS 的患病率与不符合 CFS 标准的疲劳患者，以及（ii）评估患有 POTS 的 CFS 患者（POTS-CFS）和无 POTS 的 CFS 患者（非 POTS-CFS）的活动、损伤和认知行为疗法（CBT）反应。

方法

荷兰拉德堡德大学医学中心的前瞻性队列研究。在 2013 年 6 月至 2014 年 12 月期间，连续筛查了 863 名患有持续性疲劳的患者。患者接受主动站立测试，填写问卷并佩戴活动感应设备 12 天。

结果

共有 419 名 CFS 成年患者和 341 名非 CFS 成年疲劳患者纳入研究。CFS 成年患者中 POTS 的患病率为 5.7%，而非 CFS 成年患者为 6.9%（P=0.54）。在青少年中，患病率分别为 18.2%和 17.4%（P=0.93）。患有 POTS-CFS 的成年患者年龄较小（30±12 岁 vs. 40±13 岁，P=0.001），仰卧位心率较高（71±11 次/分钟 vs. 65±9 次/分钟，P=0.009）。与非 POTS-CFS 患者相比。两组之间的严重程度和活动模式没有差异。在患有 CFS 的患者中，76%的成年患者和 67%的青少年患者符合全身性劳累不耐受疾病（SEID）标准。在符合 SEID 标准的这些患有 CFS 的患者中，POTS 的患病率与 CFS 总体人群无差异。患有 POTS-CFS 的青少年患者在接受 CBT 后临床改善程度低于非 POTS-CFS 青少年患者（58% vs. 88%，P=0.017）。