Haley R W, Kurt T L, Hom J
Epidemiology Division, Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, 75235-8874, USA.
JAMA. 1997 Jan 15;277(3):215-22.
To search for syndromes in Persian Gulf War veterans.
Two hundred forty-nine (41%) of the 606 Gulf War veterans of the Twenty-fourth Reserve Naval Mobile Construction Battalion living in 5 southeastern states participated; 145 (58%) had retired from service, and the rest were still serving in the battalion.
Participants completed a standardized survey booklet measuring the anatomical distributions or characteristics of each symptom, a booklet measuring wartime exposures, and a standard psychological personality assessment inventory. Two-stage factor analysis was used to disentangle ambiguous symptoms and identify syndromes.
Factor analysis-derived syndromes.
Of 249 participants, 175 (70%) reported having had serious health problems that most attributed to the war, and 74 (30%) reported no serious health problems. Principal factor analysis yielded 6 syndrome factors, explaining 71% of the variance. Dichotomized syndrome indicators identified the syndromes in 63 veterans (25%). Syndromes 1 ("impaired cognition," characterized by problems with attention, memory, and reasoning, as well as insomnia, depression, daytime sleepiness, and headaches), 2 ("confusion-ataxia," characterized by problems with thinking, disorientation, balance disturbances, vertigo, and impotence), and 3 ("arthro-myo-neuropathy," characterized by joint and muscle pains, muscle fatigue, difficulty lifting, and extremity paresthesias) represented strongly clustered symptoms; whereas, syndromes 4 ("phobia-apraxia"), 5 ("fever-adenopathy"), and 6 ("weakness-incontinence") involved weaker clustering and mostly overlapped syndromes 2 and 3. Veterans with syndrome 2 were 12.5 times (95% confidence interval, 3.5-44.8) more likely to be unemployed than those with no health problems. A psychological profile, found in 48.4% of those with the syndromes, differed from posttraumatic stress disorder, depression, somatoform disorder, and malingering.
These findings support the hypothesis that clusters of symptoms of many Gulf War veterans represent discrete factor analysis-derived syndromes that appear to reflect a spectrum of neurologic injury involving the central, peripheral, and autonomic nervous systems.
在海湾战争退伍军人中寻找综合征。
居住在东南部5个州的第24后备海军机动建筑营的606名海湾战争退伍军人中有249人（41%）参与；145人（58%）已退役，其余仍在该营服役。
参与者完成了一本测量每种症状的解剖分布或特征的标准化调查问卷手册、一本测量战时暴露情况的手册以及一份标准的心理人格评估量表。采用两阶段因子分析来理清模糊症状并识别综合征。
因子分析得出的综合征。
在249名参与者中，175人（70%）报告有严重健康问题，多数人将其归因于战争，74人（30%）报告无严重健康问题。主因子分析产生了6个综合征因子，解释了71%的方差。二分法综合征指标在63名退伍军人（25%）中识别出了这些综合征。综合征1（“认知受损”，特征为注意力、记忆力和推理能力问题，以及失眠、抑郁、日间嗜睡和头痛）、综合征2（“混乱 - 共济失调”，特征为思维问题、定向障碍、平衡失调、眩晕和阳痿）和综合征3（“关节 - 肌肉 - 神经病变”，特征为关节和肌肉疼痛、肌肉疲劳、举物困难和肢体感觉异常）表现出强烈的症状聚类；而综合征4（“恐惧症 - 失用症”）、综合征5（“发热 - 淋巴结病”）和综合征6（“虚弱 - 失禁”）涉及较弱的聚类，且大多与综合征2和3重叠。患有综合征2的退伍军人失业的可能性是无健康问题退伍军人的12.5倍（95%置信区间，3.5 - 44.8）。在48.4%的患有这些综合征的人中发现的一种心理特征与创伤后应激障碍、抑郁症、躯体形式障碍和诈病不同。
这些发现支持这样一种假设，即许多海湾战争退伍军人的症状群代表离散的因子分析得出的综合征，这些综合征似乎反映了涉及中枢、外周和自主神经系统的一系列神经损伤。
