Cope H, David A, Pelosi A, Mann A
Section of Epidemiology and General Practice, Institute of Psychiatry, London, UK.
Lancet. 1994 Sep 24;344(8926):864-8. doi: 10.1016/s0140-6736(94)92833-9.
We set out to determine the relation between a general practitioner (GP) diagnosis of viral illness and development of chronic fatigue 6 months later. 618 subjects who attended GPs clinics in London, south, and southwest England and who received a diagnosis of viral illness were followed prospectively and fatigue was assessed by questionnaire after 6 months. At presentation, GPs recorded fatigue in 62.6% of subjects, usually since the onset of symptoms. 502 (81.2%) subjects completed the 6-month questionnaire, of whom 88 (17.5%) met criteria for chronic fatigue and 65 (12.9%) had no reported fatigue before the viral illness. Compared with a similar group of non-postviral GP attenders, the risk ratio for chronic fatigue in the present cohort was 1.45 (95% CI 1.14-2.04). Infective symptoms did not predict fatigue 6 months later. Psychiatric morbidity, belief in vulnerability to viruses, and attributional style at initial presentation were all associated with self-designated postviral fatigue. Logistic regression showed that somatic attributional style, less definite diagnosis by the GP, and sick certification were the only significant predictors of chronic fatigue after viral infection when other factors were controlled for. Chronic severe fatigue 6 months after GP-diagnosed viral illness is related to symptom-attributional style and doctor behaviour, rather than to features of the viral illness. Some subjects with apparent postviral fatigue had complained of tiredness before their presentation with a viral illness.
我们着手确定全科医生（GP）对病毒性疾病的诊断与6个月后慢性疲劳的发生之间的关系。对618名在伦敦、英格兰南部和西南部的全科医生诊所就诊且被诊断为病毒性疾病的受试者进行前瞻性随访，并在6个月后通过问卷调查评估疲劳情况。就诊时，全科医生记录了62.6%受试者的疲劳情况，通常是自症状出现以来。502名（81.2%）受试者完成了6个月的问卷调查，其中88名（17.5%）符合慢性疲劳标准，65名（12.9%）在病毒性疾病之前未报告有疲劳症状。与一组类似的非病毒感染后就诊的全科医生患者相比，本队列中慢性疲劳的风险比为1.45（95%置信区间1.14 - 2.04）。感染症状并不能预测6个月后的疲劳情况。精神疾病发病率、对病毒易感性的信念以及初次就诊时的归因方式均与自我认定的病毒感染后疲劳有关。逻辑回归显示，在控制其他因素后，躯体归因方式、全科医生诊断不明确以及病假证明是病毒感染后慢性疲劳的唯一显著预测因素。全科医生诊断为病毒性疾病6个月后的慢性严重疲劳与症状归因方式和医生行为有关，而非与病毒性疾病的特征有关。一些明显有病毒感染后疲劳的受试者在出现病毒性疾病之前就曾抱怨过疲劳。
