Research Center for CFS/ME, Daejeon Hospital of Daejeon University, Daejeon, Republic of Korea; Institute of Bioscience & Integrative Medicine, Daejeon University, Daejeon, Republic of Korea.
Department of Immunology, National Center of Neurology and Psychiatry, Tokyo, Japan.
Autoimmun Rev. 2024 Feb;23(2):103484. doi: 10.1016/j.autrev.2023.103484. Epub 2023 Nov 26.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition characterized by an elusive etiology and pathophysiology. This study aims to evaluate the pathological role of neuroinflammation in ME/CFS by conducting an exhaustive analysis of 65 observational studies. Four neuroimaging techniques, including magnetic resonance imaging (MRI), magnetic resonance spectroscopy (MRS), electroencephalography (EEG), and positron emission tomography (PET), were employed to comparatively assess brain regional structure, metabolite profiles, electrical activity, and glial activity in 1529 ME/CFS patients (277 males, 1252 females) and 1715 controls (469 males, 1246 females). Clinical characteristics, including sex, age, and fatigue severity, were consistent with established epidemiological patterns. Regional alterations were most frequently identified in the cerebral cortex, with a notable focus on the frontal cortex. However, our meta-analysis data revealed a significant hypoactivity in the insular and thalamic regions, contrary to observed frequencies. These abnormalities, occurring in pivotal network hubs bridging reason and emotion, disrupt connections with the limbic system, contributing to the hallmark symptoms of ME/CFS. Furthermore, we discuss the regions where neuroinflammatory features are frequently observed and address critical neuroimaging limitations, including issues related to inter-rater reliability. This systematic review serves as a valuable guide for defining regions of interest (ROI) in future neuroimaging investigations of ME/CFS.
肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）是一种使人衰弱的疾病，其病因和病理生理学难以捉摸。本研究旨在通过对 65 项观察性研究进行详尽分析，评估神经炎症在 ME/CFS 中的病理作用。使用了四种神经影像学技术，包括磁共振成像（MRI）、磁共振波谱（MRS）、脑电图（EEG）和正电子发射断层扫描（PET），以比较性地评估 1529 名 ME/CFS 患者（277 名男性，1252 名女性）和 1715 名对照者（469 名男性，1246 名女性）的大脑区域结构、代谢物谱、电活动和神经胶质活性。临床特征，包括性别、年龄和疲劳严重程度，与既定的流行病学模式一致。区域改变最常发生在大脑皮层，特别是额皮质。然而，我们的荟萃分析数据显示，岛叶和丘脑区域的活动显著减少，与观察到的频率相反。这些异常发生在连接理智和情感的关键网络枢纽，破坏了与边缘系统的连接，导致 ME/CFS 的标志性症状。此外，我们讨论了经常观察到神经炎症特征的区域，并解决了关键的神经影像学限制，包括与评分者间可靠性相关的问题。本系统评价为定义 ME/CFS 神经影像学研究中的感兴趣区域（ROI）提供了有价值的指南。
