Oesch-Régeni Boglárka, Germann Nicolas, Hafer Georg, Schmid Dagmar, Arn Norbert
Division of Nephrology and Transplant Medicine, HOCH Health Eastern Switzerland, Cantonal Hospital St. Gallen, 9000 St. Gallen, Switzerland.
Department of Internal Medicine, Cantonal Hospital Münsterlingen, 8596 Münsterlingen, Switzerland.
J Clin Med. 2025 May 29;14(11):3802. doi: 10.3390/jcm14113802.
Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a debilitating condition with not fully understood causes, though evidence points to immune system involvement and possible autoimmunity. ME/CFS could be triggered by various infectious pathogens, like SARS-CoV-2; furthermore, a subset of the post-COVID-19 condition (PCC) patients fulfill the diagnostic criteria of ME/CFS. According to the Canadian Consensus Criteria (CCC), the presence of specific symptoms such as fatigue, post-exertional malaise, sleep dysfunction, pain, neurological/cognitive manifestations, and symptoms from at least two of the following categories lead to the diagnosis of ME/CFS: autonomic, neuroendocrine, and immune manifestation. In this study, the patient selection was based on the identification of ME/CFS patients with elevated autoantibodies, regardless of the triggering factor of their condition. The aim of this study was to identify ME/CFS patients among long COVID patients with elevated autoantibodies. In seven cases, plasmapheresis (PE) and intravenous immunoglobulins (IVIGs) with repetitive autoantibody measurements were applied: four PE sessions on days 1, 5, 30, and 60, and a low-dose IVIG therapy after each treatment. Antibodies were measured before the first PE and two weeks after the last PE session. To monitor clinical outcomes, the following somatic and psychometric follow-up assessments were conducted before the first PE, 2 weeks after the second, and 2 weeks after the last PE: the Schellong test, ISI (insomnia), FSS (fatigue), HADS (depression and anxiety), and EQ-5D-5L (quality of life) questionnaires. There was a negative association between both the β2-adrenergic and M3-muscarinic receptor autoantibody concentration and the quality of life measurements assessed with the EQ-5D-5L questionnaire. Per 1 U/mL increase in the concentration levels of β2-adrenergic receptor antibodies or M3-muscarinic acetylcholine receptor antibodies, the EQ-5D-5L index score [-0.59 to 1] decreased by 0.01 (0.63%) or 0.02 (1.26%), respectively. There were no significant associations between the ISI, HADS, and FSS questionnaires and the β1-adrenergic and M4-muscarinic receptor antibodies titers. After a thorough selection of patients with present autoantibodies, this pilot study found negative associations concerning autoantibody concentration and somatic, as well as psychological wellbeing. To validate these promising feasibility study results-indicating the potential therapeutic potential of antibody-lowering methods-further investigation with larger sample sizes is needed.
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，其病因尚未完全明确，不过有证据表明免疫系统参与其中且可能存在自身免疫。ME/CFS可能由多种传染性病原体引发，如严重急性呼吸综合征冠状病毒2（SARS-CoV-2）；此外，一部分新冠后状况（PCC）患者符合ME/CFS的诊断标准。根据加拿大共识标准（CCC），出现疲劳、劳累后不适、睡眠功能障碍、疼痛、神经/认知表现等特定症状，以及至少以下两类症状，可诊断为ME/CFS：自主神经、神经内分泌和免疫表现。在本研究中，患者选择基于识别自身抗体升高的ME/CFS患者，无论其病情的触发因素如何。本研究的目的是在自身抗体升高的长新冠患者中识别出ME/CFS患者。对7例患者进行了血浆置换（PE）和静脉注射免疫球蛋白（IVIG），并重复测量自身抗体：在第1、5、30和60天进行4次PE治疗，每次治疗后进行低剂量IVIG治疗。在首次PE治疗前和最后一次PE治疗后两周测量抗体。为监测临床结果，在首次PE治疗前、第二次PE治疗后2周和最后一次PE治疗后2周进行了以下躯体和心理测量学随访评估：谢隆试验、ISI（失眠）、FSS（疲劳）、HADS（抑郁和焦虑）以及EQ-5D-5L（生活质量）问卷。β2肾上腺素能和M3毒蕈碱受体自身抗体浓度与使用EQ-5D-5L问卷评估的生活质量测量结果之间存在负相关。β2肾上腺素能受体抗体或M3毒蕈碱乙酰胆碱受体抗体浓度每升高1 U/mL，EQ-5D-5L指数评分[-0.59至1]分别降低0.01（0.63%）或0.02（1.26%）。ISI、HADS和FSS问卷与β1肾上腺素能和M4毒蕈碱受体抗体滴度之间无显著关联。在对现有自身抗体的患者进行全面筛选后，这项初步研究发现自身抗体浓度与躯体以及心理健康之间存在负相关。为验证这些有前景的可行性研究结果——表明降低抗体方法的潜在治疗潜力——需要更大样本量的进一步研究。
