慢性疲劳综合征患者中具有体位性心动过速综合征的新型亚组的临床特征。

Clinical characteristics of a novel subgroup of chronic fatigue syndrome patients with postural orthostatic tachycardia syndrome.

机构信息

Institute for Ageing & Health, Newcastle University, Newcastle, UK.

出版信息

J Intern Med. 2013 May;273(5):501-10. doi: 10.1111/joim.12022. Epub 2013 Jan 7.

DOI:10.1111/joim.12022

PMID:23206180

Abstract

OBJECTIVES

A significant proportion of patients with chronic fatigue syndrome (CFS) also have postural orthostatic tachycardia syndrome (POTS). We aimed to characterize these patients and differentiate them from CFS patients without POTS in terms of clinical and autonomic features.

METHODS

A total of 179 patients with CFS (1994 Centers for Disease Control and Prevention criteria) attending one of the largest Department of Health-funded CFS clinical services were included in this study. Outcome measures were as follows: (i) symptom assessment tools including the fatigue impact scale, Chalder fatigue scale, Epworth sleepiness scale (ESS), orthostatic grading scale (OGS) and hospital anxiety and depression scale (HADS-A and -D, respectively), (ii) autonomic function analysis including heart rate variability and (iii) haemodynamic responses including left ventricular ejection time and systolic blood pressure drop upon standing.

RESULTS

CFS patients with POTS (13%, n = 24) were younger (29 ± 12 vs. 42 ± 13 years, P < 0.0001), less fatigued (Chalder fatigue scale, 8 ± 4 vs. 10 ± 2, P = 0.002), less depressed (HADS-D, 6 ± 4 vs. 9 ± 4, P = 0.01) and had reduced daytime hypersomnolence (ESS, 7 ± 6 vs. 10 ± 5, P = 0.02), compared with patients without POTS. In addition, they exhibited greater orthostatic intolerance (OGS, 11 ± 5; P < 0.0001) and autonomic dysfunction. A combined clinical assessment tool of ESS ≤9 and OGS ≥9 identifies accurately CFS patients with POTS with 100% positive and negative predictive values.

CONCLUSIONS

The presence of POTS marks a distinct clinical group of CFS patents, with phenotypic features differentiating them from those without POTS. A combination of validated clinical assessment tools can determine which CFS patients have POTS with a high degree of accuracy, and thus potentially identify those who require further investigation and consideration for therapy to control heart rate.

摘要

目的

慢性疲劳综合征（CFS）患者中有相当一部分还患有体位性心动过速综合征（POTS）。我们旨在从临床和自主功能特征方面对这些患者进行特征描述并与无 POTS 的 CFS 患者进行区分。

方法

本研究纳入了 179 名符合疾病控制与预防中心（CDC）1994 年制定的 CFS 标准的患者，这些患者均在英国最大的卫生部门资助的 CFS 临床服务中心就诊。研究的结局指标包括：（i）症状评估工具，包括疲劳影响量表、Chalder 疲劳量表、Epworth 嗜睡量表（ESS）、体位分级量表（OGS）和医院焦虑抑郁量表（HADS-A 和 HADS-D）；（ii）自主功能分析，包括心率变异性；（iii）血流动力学反应，包括左心室射血时间和站立时收缩压下降。

结果

患有 POTS（13%，n=24）的 CFS 患者年龄更小（29 ± 12 岁 vs. 42 ± 13 岁，P＜0.0001）、疲劳程度更低（Chalder 疲劳量表，8 ± 4 分 vs. 10 ± 2 分，P=0.002）、抑郁程度更低（HADS-D，6 ± 4 分 vs. 9 ± 4 分，P=0.01）、白天过度嗜睡程度更低（ESS，7 ± 6 分 vs. 10 ± 5 分，P=0.02），与无 POTS 的 CFS 患者相比。此外，他们表现出更严重的体位不耐受（OGS，11 ± 5；P＜0.0001）和自主功能障碍。ESS≤9 和 OGS≥9 的联合临床评估工具可准确识别出患有 POTS 的 CFS 患者，其阳性预测值和阴性预测值均为 100%。