Wilson A, Hickie I, Lloyd A, Hadzi-Pavlovic D, Boughton C, Dwyer J, Wakefield D
Department of Psychiatry, Prince Henry Hospital, Little Bay, NSW, Australia.
BMJ. 1994 Mar 19;308(6931):756-9. doi: 10.1136/bmj.308.6931.756.
To examine the predictors of long term outcome for patients with the chronic fatigue syndrome.
Cohort study.
139 subjects previously enrolled in two treatment trials; 103 (74%) were reassessed a mean of 3.2 years after start of the trials.
University hospital referral centre.
Age at onset, duration of illness, psychological and immunological status at initial assessment. Ongoing symptom severity, levels of disability, and immunological function at follow up.
65 subjects had improved but only six reported no current symptoms. An alternative medical diagnosis had been made in two and psychiatric illness diagnosed in 20. The assignment of a primary psychiatric diagnosis at follow up and the strength of the belief that a physical disease process explained all symptoms at entry to the trials both predicted poor outcome. Age at onset of illness, duration of illness, neuroticism, premorbid psychiatric diagnoses, and cell mediated immune function did not predict outcome.
Though most patients with the chronic fatigue syndrome improve, a substantial proportion remain functionally impaired. Psychological factors such as illness attitudes and coping style seem more important predictors of long term outcome than immunological or demographic variables.
探讨慢性疲劳综合征患者长期预后的预测因素。
队列研究。
139名曾参与两项治疗试验的受试者；其中103名（74%）在试验开始后平均3.2年时接受了重新评估。
大学医院转诊中心。
发病年龄、病程、初始评估时的心理和免疫状态。随访时的持续症状严重程度、残疾水平和免疫功能。
65名受试者病情有所改善，但只有6名表示目前没有症状。另有2名被诊断为其他医学疾病，20名被诊断为精神疾病。随访时原发性精神疾病诊断以及试验开始时认为躯体疾病过程可解释所有症状的信念强度均预示着预后不良。发病年龄、病程、神经质、病前精神疾病诊断以及细胞介导免疫功能均不能预测预后。
虽然大多数慢性疲劳综合征患者病情有所改善，但仍有相当一部分患者存在功能障碍。疾病态度和应对方式等心理因素似乎比免疫或人口统计学变量更能预测长期预后。
