肌痛性脑脊髓炎和慢性疲劳综合征患者体位性不耐受发生过程中向失衡的范式转变。
Paradigm shift to disequilibrium in the genesis of orthostatic intolerance in patients with myalgic encephalomyelitis and chronic fatigue syndrome.
作者信息
Miwa Kunihisa, Inoue Yukichi
机构信息
Department of Internal Medicine, Miwa Naika Clinic, Toyama, Japan.
Department of Neurology, Toyama Prefectural Rehabilitation Hospital & Support Center for Children with Disabilities, Toyama, Japan.
出版信息
Int J Cardiol Hypertens. 2020 May 20;5:100032. doi: 10.1016/j.ijchy.2020.100032. eCollection 2020 Jun.
BACKGROUND
Orthostatic intolerance (OI) markedly impairs activities of daily living in patients with myalgic encephalomyelitis (ME) or chronic fatigue syndrome. OI is surmised to be a cardiovascular symptom correlated with cerebral hypo-perfusion and exaggerated sympathetic activation. Postural instability or disequilibrium may be part of the etiology of OI.
METHODS
The study comprised 72 patients with ME (18 men, 54 women; mean age, 37 ± 10 years) who underwent neurological examinations and the 10 min standing test. We quantified disequilibrium (instability upon standing with feet together and eyes shut), ability to complete the 10 min standing test, and postural orthostatic tachycardia (POT) during the test.
RESULTS
Disequilibrium was detected in 23/72 (32%) patients and POT in 16 (22%). Nineteen (26%) patients failed to complete the 10 min standing test; disequilibrium was significantly more common in the 19- patient subgroup than in the 53-patient test-completing subgroup (89% vs. 11%, p < 0.01). However, the rate of POT was not different between the groups (21% vs. 23%, p = 1.00). Compared with the 49 (68%) patients without disequilibrium, the 23 (32%) patients with disequilibrium were significantly more likely to have failed to complete the test (74% vs. 4%, p < 0.01). The rate of POT was comparable between the groups (23% vs. 22%, p = 1.00). Among patients with disequilibrium who failed to complete the 10 min standing test and had a previous record, 6/8 had completed the test 6-24 months earlier when all six had reported no disequilibrium.
CONCLUSION
Disequilibrium should be recognized as an important cause of OI in patients with ME.
背景
直立不耐受（OI）显著损害了肌痛性脑脊髓炎（ME）或慢性疲劳综合征患者的日常生活活动能力。OI被推测是一种与脑灌注不足和过度交感神经激活相关的心血管症状。姿势不稳或失衡可能是OI病因的一部分。
方法
该研究纳入了72例ME患者（18例男性，54例女性；平均年龄37±10岁），这些患者接受了神经系统检查和10分钟站立试验。我们对失衡（双脚并拢站立且闭眼时的不稳）、完成10分钟站立试验的能力以及试验期间的姿势性直立性心动过速（POT）进行了量化。
结果
23/72（32%）的患者检测到失衡，16例（22%）检测到POT。19例（26%）患者未能完成10分钟站立试验；在这19例患者亚组中，失衡比53例完成试验的患者亚组更为常见（89%对11%，p<0.01）。然而，两组之间的POT发生率没有差异（21%对23%，p=1.00）。与49例（68%）无失衡的患者相比，23例（32%）有失衡的患者更有可能未能完成试验（74%对4%，p<0.01）。两组之间的POT发生率相当（23%对22%，p=1.00）。在有失衡且未能完成10分钟站立试验并有既往记录的患者中，6/8在6 - 24个月前完成了试验，当时所有6例均报告无失衡。
结论
失衡应被视为ME患者OI的一个重要原因。
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