Crofford L J, Engleberg N C, Demitrack M A
Department of Internal Medicine, University of Michigan Medical Center, Ann Arbor 48109, USA.
Baillieres Clin Rheumatol. 1996 May;10(2):365-78. doi: 10.1016/s0950-3579(96)80022-7.
Fibromyalgia (FM) falls into the spectrum of what might be termed 'stress-associated syndromes' by virtue of frequent onset after acute or chronic stressors and apparent exacerbation of symptoms during periods of physical or emotional stress. Patients with FM exhibit disturbances of the major stress-response systems, the HPA axis and the sympathetic nervous system. Integrated basal cortisol levels measured by 24-hour urine-free cortisol are low. FM patients display a unique pattern of HPA axis perturbation characterized by exaggerated ACTH response to exogenous CRH or to endogenous activators of CRH such as insulin-induced hypoglycaemia. The cortisol response to increased ACTH in these stress paradigms is blunted, as is the the cortisol response to exercise. Functional analysis suggests that FM patients may also exhibit disturbed autonomic system activity. For example, plasma NPY, a peptide co-localized with norepinephrine in the sympathetic nervous system, is low in patients with FM. Abnormalities of related neuronal systems, particularly decreased serotonergic activity, may contribute to the observed neuroendocrine perturbations in FM. Finally, other neuroendocrine systems, including the growth hormone axis, are also abnormal in FM patients. Many clinical features of FM and related disorders, such as widespread pain and fatigue, could be related to the observed neuroendocrine perturbations. This hypothesis is supported by the observation that many useful treatments for FM affect the function of these central nervous system centres. Further clarification of the role of neuroendocrine abnormalities in patients with FM, and the relationship of these disturbances with particular symptoms, may lead to improved therapeutic strategies.
纤维肌痛（FM）属于可被称为“应激相关综合征”的范畴，这是因为它常在急性或慢性应激源后频繁发病，且在身体或情绪应激期间症状明显加重。FM患者表现出主要应激反应系统，即下丘脑 - 垂体 - 肾上腺（HPA）轴和交感神经系统的紊乱。通过24小时尿游离皮质醇测量的综合基础皮质醇水平较低。FM患者表现出一种独特的HPA轴扰动模式，其特征是促肾上腺皮质激素（ACTH）对外源性促肾上腺皮质激素释放激素（CRH）或对CRH的内源性激活剂（如胰岛素诱导的低血糖）反应过度。在这些应激模式下，皮质醇对ACTH增加的反应减弱，对运动的皮质醇反应也是如此。功能分析表明，FM患者可能还表现出自主神经系统活动紊乱。例如，血浆神经肽Y（NPY），一种与去甲肾上腺素在交感神经系统中共定位的肽，在FM患者中含量较低。相关神经元系统的异常，特别是血清素能活性降低，可能导致FM中观察到的神经内分泌扰动。最后，包括生长激素轴在内的其他神经内分泌系统在FM患者中也异常。FM及相关疾病的许多临床特征，如广泛疼痛和疲劳，可能与观察到的神经内分泌扰动有关。这一假设得到以下观察结果的支持：许多对FM有效的治疗方法会影响这些中枢神经系统中心的功能。进一步阐明神经内分泌异常在FM患者中的作用，以及这些紊乱与特定症状的关系，可能会带来改进的治疗策略。
