慢性疲劳综合征（CFS/ME）基于症状的表型和英国及荷兰两个临床队列成年患者的 1 年治疗结果。

Chronic fatigue syndrome (CFS/ME) symptom-based phenotypes and 1-year treatment outcomes in two clinical cohorts of adult patients in the UK and The Netherlands.

机构信息

Population Health Sciences, Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol BS8 2BN, UK.

出版信息

J Psychosom Res. 2018 Jan;104:29-34. doi: 10.1016/j.jpsychores.2017.11.007. Epub 2017 Nov 8.

DOI:10.1016/j.jpsychores.2017.11.007

PMID:29275782

Abstract

OBJECTIVE

We previously described symptom-based chronic fatigue syndrome (CFS/ME) phenotypes in clinical assessment data from 7041 UK and 1392 Dutch adult CFS/ME patients. Here we aim to replicate these phenotypes in a more recent UK patient cohort, and investigate whether phenotypes are associated with 1-year treatment outcome.

METHODS

12 specialist CFS/ME services (11 UK, 1 NL) recorded the presence/absence of 5 symptoms (muscle pain, joint pain, headache, sore throat, and painful lymph nodes) which can occur in addition to the 3 symptoms (post-exertional malaise, cognitive dysfunction, and disturbed/unrefreshing sleep) that are present for almost all patients. Latent Class Analysis (LCA) was used to assign symptom profiles (phenotypes). Multinomial logistic regression models were fitted to quantify associations between phenotypes and overall change in health 1year after the start of treatment.

RESULTS

Baseline data were available for N=918 UK and N=1392 Dutch patients, of whom 416 (45.3%) and 912 (65.5%) had 1-year follow-up data, respectively. 3- and 4-class phenotypes identified in the previous UK patient cohort were replicated in the new UK cohort. UK patients who presented with 'polysymptomatic' and 'pain-only' phenotypes were 57% and 67% less likely (multinomial odds ratio (MOR) 0.43 (95% CI 0.19-0.94) and 0.33 (95% CI 0.13-0.84)) to report that their health was "very much better" or "much better" than patients who presented with an 'oligosymptomatic' phenotype. For Dutch patients, polysymptomatic and pain-only phenotypes were associated with 72% and 55% lower odds of improvement (MOR 0.28 (95% CI 0.11, 0.69) and 0.45 (95% CI 0.21, 0.99)) compared with oligosymptomatic patients.

CONCLUSIONS

Adult CFS/ME patients with multiple symptoms or pain symptoms who present for specialist treatment are much less likely to report favourable treatment outcomes than patients who present with few symptoms.

摘要

目的

我们之前在来自 7041 名英国和 1392 名荷兰成年慢性疲劳综合征（CFS/ME）患者的临床评估数据中描述了基于症状的 CFS/ME 表型。在此，我们旨在复制最近英国患者队列中的这些表型，并研究表型是否与 1 年治疗结果相关。

方法

12 家 CFS/ME 专科服务机构（11 家英国，1 家荷兰）记录了 5 种症状（肌肉疼痛、关节疼痛、头痛、喉咙痛和疼痛性淋巴结）的存在/缺失，这些症状除了几乎所有患者都存在的 3 种症状（活动后不适、认知功能障碍和睡眠障碍/不恢复）之外还会出现。潜在类别分析（LCA）用于分配症状谱（表型）。使用多项逻辑回归模型来量化表型与治疗开始后 1 年健康总体变化之间的关联。

结果

英国队列中，918 名患者和荷兰队列中，1392 名患者分别有基线数据，其中分别有 416 名（45.3%）和 912 名（65.5%）患者有 1 年随访数据。在之前的英国患者队列中确定的 3 类和 4 类表型在新的英国队列中得到了复制。呈现“多症状”和“仅疼痛”表型的英国患者报告其健康状况“非常好”或“好得多”的可能性分别比呈现“少症状”表型的患者低 57%和 67%（多项优势比（MOR）0.43（95%CI 0.19-0.94）和 0.33（95%CI 0.13-0.84））。对于荷兰患者，多症状和疼痛仅表型与改善的可能性降低 72%和 55%相关（MOR 0.28（95%CI 0.11，0.69）和 0.45（95%CI 0.21，0.99））与少症状患者相比。