Department of Neurology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, New York, NY, 10029, USA.
Division of High-Consequence Pathogens and Pathology, Centers for Disease Control and Prevention, National Center for Emerging and Zoonotic Infectious Diseases, 1600 Clifton Road, Atlanta, GA, 30333, USA.
J Transl Med. 2022 Feb 16;20(1):95. doi: 10.1186/s12967-022-03289-8.
Orthostatic intolerance-OI is common in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome-ME/CFS. We used a 10-min passive vertical lean test as orthostatic challenge-OC and measured changes in vitals and end tidal CO (eTCO2). An abnormal physiologic response to OC was identified in 60% of the 63 patients evaluated from one to three times over several years. Hypocapnia, either resting or induced by OC, was the most frequent abnormality, followed by postural orthostatic tachycardia.
Evaluate the physiologic response of patients with ME/CFS to a standardized OC.
Respiratory and heart rate, blood pressure and eTCO were recorded twice at the end of 10-min supine rest and then every minute during the 10-min lean. Hypocapnia was eTCO ≤ 32 mmHg. Orthostatic tachycardia was heart rate increase ≥ 30 beats per minute compared with resting or ≥ 120 BPM. Orthostatic hypotension was decreased systolic pressure ≥ 20 mmHg from baseline. Tachypnea was respiratory rate of ≥ 20 breaths per minute-either supine or leaning. Questionnaire data on symptom severity, quality of life and mood were collected at visit #2.
63 consecutive patients fulfilling the 1994 case definition for CFS underwent lean testing at first visit and then annually at visit 2 (n = 48) and 3 (n = 29).
Supine hypocapnia; orthostatic tachycardia, hypocapnia or hypotension.
The majority of ME/CFS patients (60.3%, 38/63) had an abnormality detected during a lean test at any visit (51%, 50% and 45% at visits 1, 2 and 3, respectively). Hypocapnia at rest or induced by OC was more common and more likely to persist than postural orthostatic tachycardia. Anxiety scores did not differ between those with and without hypocapnia.
The 10-min lean test is useful in evaluation of OI in patients with ME/CFS. The most frequent abnormality, hypocapnia, would be missed without capnography.
直立不耐受-OI 在肌痛性脑脊髓炎/慢性疲劳综合征-ME/CFS 中很常见。我们使用 10 分钟被动垂直倾斜测试作为直立挑战-OC，并测量生命体征和呼气末 CO（eTCO2）的变化。在评估的 63 名患者中，有 60%在几年内进行了 1 到 3 次评估，发现对 OC 的异常生理反应。低碳酸血症，无论是休息时还是 OC 引起的，是最常见的异常，其次是直立性心动过速。
评估 ME/CFS 患者对标准化 OC 的生理反应。
在 10 分钟仰卧休息结束时记录两次呼吸和心率、血压和 eTCO，然后在 10 分钟倾斜期间每分钟记录一次。低碳酸血症为 eTCO≤32mmHg。直立性心动过速为与休息时或≥120 BPM 相比，心率增加≥30 次/分钟。直立性低血压为收缩压从基线下降≥20mmHg。呼吸急促为每分钟呼吸≥20 次，无论是仰卧还是倾斜。在第 2 次就诊时收集症状严重程度、生活质量和情绪的问卷数据。
63 名连续符合 1994 年 CFS 病例定义的患者在首次就诊时进行倾斜测试，然后在第 2 次就诊（n=48）和第 3 次就诊（n=29）时每年进行一次。
仰卧位低碳酸血症；直立性心动过速、低碳酸血症或低血压。
大多数 ME/CFS 患者（60.3%，38/63）在任何就诊时的倾斜测试中发现异常（就诊 1、2 和 3 时分别为 51%、50%和 45%）。休息时或 OC 引起的低碳酸血症比直立性心动过速更常见且更可能持续存在。焦虑评分在低碳酸血症和无低碳酸血症患者之间没有差异。
10 分钟倾斜测试在评估 ME/CFS 患者的 OI 中很有用。如果没有二氧化碳图，最常见的异常低碳酸血症将被遗漏。
