Sparks P J, Daniell W, Black D W, Kipen H M, Altman L C, Simon G E, Terr A I
Providence Medical Center, Seattle, Washington 98122.
J Occup Med. 1994 Jul;36(7):718-30.
Multiple chemical sensitivity syndrome (MCS) does not appear to fit established principles of toxicology. Yet social, political, and economic forces are demanding that MCS be defined medically, even though to date scientific studies have not identified pathogenic mechanisms for the condition or any objective diagnostic criteria. Consequently, a working definition of MCS can rely only on an individual's subjective symptoms of distress and attribution to environmental exposures rather than currently measurable objective evidence of disease. Nevertheless, patients labeled with MCS are clearly distressed and many are functionally disabled. In this review, four theories of causation are explored: (1) MCS is a purely biologic/physical or psychophysiologic reaction to low-level chemical exposures. (2) MCS symptoms may be elicited by low-level environmental chemical exposures, but the sensitivity is initiated by psychologic stress. (3) MCS is a misdiagnosis and chemical exposure is not the cause. The symptoms may be due to misdiagnosed physical or psychologic illness. (4) MCS is an illness belief system manifest by culturally shaped illness behavior. Areas for further research regarding the etiologies of MCS are suggested. Recognizing that the cause of the syndrome may be multifactorial, strategies are proposed for clinical evaluation and management in Part II of this manuscript using a biopsychosocial model of illness.
多重化学物质敏感综合征（MCS）似乎并不符合既定的毒理学原理。然而，社会、政治和经济力量要求从医学角度对MCS进行定义，尽管迄今为止科学研究尚未确定该病症的致病机制或任何客观诊断标准。因此，MCS的暂行定义只能依赖于个体的主观不适症状以及将这些症状归因于环境暴露，而非目前可测量的疾病客观证据。尽管如此，被诊断为MCS的患者明显感到痛苦，许多人功能受限。在本综述中，探讨了四种病因理论：（1）MCS是对低水平化学暴露的纯粹生物/生理或心理生理反应。（2）MCS症状可能由低水平环境化学暴露引发，但敏感性是由心理压力引发的。（3）MCS是误诊，化学暴露不是病因。症状可能归因于误诊的身体或心理疾病。（4）MCS是一种由文化塑造的疾病行为所表现出的疾病信念系统。本文提出了关于MCS病因的进一步研究方向。认识到该综合征的病因可能是多因素的，本手稿第二部分使用生物心理社会疾病模型提出了临床评估和管理策略。
