Wessely S, Chalder T, Hirsch S, Pawlikowska T, Wallace P, Wright D J
Department of Psychological Medicine, King's College School of Medicine and Dentistry, London, UK.
Lancet. 1995 May 27;345(8961):1333-8. doi: 10.1016/s0140-6736(95)92537-6.
The idea that chronic fatigue has an infectious origin has become popular, but the main evidence for such an association has come from retrospective case-control studies, which are subject to ascertainment bias. We report a prospective study of the outcome of clinically diagnosed infections in patients presenting to UK general practitioners. Questionnaires assessing fatigue and psychiatric morbidity were sent to all patients aged 18-45 years in the study practices. The prevalence of chronic fatigue and chronic fatigue syndrome was then ascertained among 1199 people aged 18-45 who presented to the general practitioners with symptomatic infections and in 1167 people who attended the surgeries for other reasons. 84% were followed up at 6 months. 9.9% of cases and 11.7% of controls reported chronic fatigue (odds ratio 1.0 [95% CI 0.6-1.1]). There were no differences in the proportions who met various criteria for chronic fatigue syndrome. No effect of infection was noted when we excluded subjects who reported fatigue or psychological morbidity at the baseline screening. The strongest independent predictors of postinfectious fatigue were fatigue assessed before presentation with clinical infection (3.0 [1.9-4.7]) and psychological distress before presentation (1.8 [1.2-2.9]) and at presentation with the acute infection (1.8 [1.1-2.8]). There was no effect of sex or social class. Our study shows no evidence that common infective episodes in primary care are related to the onset of chronic fatigue or chronic fatigue syndrome.
慢性疲劳具有感染性起源这一观点已变得流行，但这种关联的主要证据来自回顾性病例对照研究，而这类研究存在确诊偏倚。我们报告了一项对英国全科医生所接诊患者临床诊断感染结局的前瞻性研究。向研究机构中所有18至45岁的患者发放了评估疲劳和精神疾病发病率的问卷。随后确定了1199名因有症状感染前来全科医生处就诊的18至45岁人群以及1167名因其他原因到诊所就诊的人群中慢性疲劳和慢性疲劳综合征的患病率。84%的人在6个月时接受了随访。9.9%的病例和11.7%的对照报告有慢性疲劳（比值比1.0 [95%可信区间0.6 - 1.1]）。符合慢性疲劳综合征各种标准的比例没有差异。当我们排除在基线筛查时报告有疲劳或心理疾病的受试者后，未发现感染有影响。感染后疲劳最强的独立预测因素是在出现临床感染之前评估的疲劳（3.0 [1.9 - 4.7]）、出现之前的心理困扰（1.8 [1.2 - 2.9]）以及在出现急性感染时的心理困扰（1.8 [1.1 - 2.8]）。性别和社会阶层没有影响。我们的研究没有表明初级保健中的常见感染发作与慢性疲劳或慢性疲劳综合征的发病有关。
