Amato A A, McVey A, Cha C, Matthews E C, Jackson C E, Kleingunther R, Worley L, Cornman E, Kagan-Hallet K
Department of Neurology, Wilford Hall Medical Center, San Antonio, TX, USA.
Neurology. 1997 Jan;48(1):4-12. doi: 10.1212/wnl.48.1.4.
To comprehensively evaluate complaints of muscle fatigue, weakness, and myalgias in Persian Gulf veterans (PGV).
Approximately 700,000 American troops were deployed to the Persian Gulf during Desert Shield and Desert Storm. Upon return from the Gulf, some PGV developed unexplained illnesses, and special referral centers were established for the evaluation of these patients. Among the most common symptoms of these PGV are fatigue, weakness, and myalgias. An Institute of Medicine committee recommended further exploration into the possible etiologies of these complaints.
Twenty PGV with severe muscle fatigue, weakness, or myalgias that interfered with their daily activities were referred for an extensive prospective neuromuscular evaluation. Routine laboratory studies included serum creatine kinase (CK), erythrocyte sedimentation rate, thyroid function tests, and exercise forearm tests. All patients received nerve conduction studies (NCS), repetitive nerve stimulation, quantitative and single-fiber electromyography (EMG), and muscle biopsies.
Manual muscle strength examinations were normal in all patients. Six patients had mildly elevated CKs (range 223 to 768 IU/l); otherwise, laboratory tests were unremarkable. NCS were normal except in 2 patients with carpal tunnel syndrome. Quantitative EMGs were normal. One patient had mildly increased jitter on single-fiber EMG. Muscle biopsies demonstrated minor nonspecific abnormalities in 5 patients (i.e., increased central nuclei, rare necrotic fibers, tubular aggregates).
Despite severe subjective symptoms, most of our patients had no objective evidence of neuromuscular disease. Mildly increased CKs or nonspecific histologic abnormalities on muscle biopsy were evident in 8 patients but were not believed to be clinically significant in most. We found no evidence of a specific neuromuscular disorder in any patient. Exposures to toxins during the Persian Gulf War were not likely responsible for our patients' symptoms.
全面评估海湾战争退伍军人（PGV）的肌肉疲劳、无力和肌痛主诉。
在沙漠盾牌行动和沙漠风暴行动期间，约70万美国军队被部署到波斯湾。从海湾地区返回后，一些PGV出现了不明原因的疾病，为此设立了专门的转诊中心来评估这些患者。这些PGV最常见的症状包括疲劳、无力和肌痛。医学研究所的一个委员会建议进一步探究这些主诉可能的病因。
20名有严重肌肉疲劳、无力或肌痛且影响日常活动的PGV被转诊进行广泛的前瞻性神经肌肉评估。常规实验室检查包括血清肌酸激酶（CK）、红细胞沉降率、甲状腺功能测试和运动前臂测试。所有患者均接受神经传导研究（NCS）、重复神经刺激、定量和单纤维肌电图（EMG）以及肌肉活检。
所有患者的徒手肌力检查均正常。6名患者的CK轻度升高（范围为223至768 IU/l）；除此之外，实验室检查无异常。除2名患有腕管综合征的患者外，NCS均正常。定量EMG正常。1名患者的单纤维EMG上抖动轻度增加。5名患者的肌肉活检显示有轻微的非特异性异常（即中央核增多、罕见坏死纤维、管状聚集物）。
尽管有严重的主观症状，但我们的大多数患者没有神经肌肉疾病的客观证据。8名患者的CK轻度升高或肌肉活检有非特异性组织学异常，但大多数情况下被认为无临床意义。我们在任何患者中均未发现特定神经肌肉疾病的证据。海湾战争期间接触毒素不太可能是我们患者症状的原因。
