慢性疲劳综合征"疲郁同病"特征内涵研究

Chronic Fatigue Syndrome (CFS) mainly complained by persistent weak has been always confused by mental illness, neurological diseases or somatoform disorders among the western medicine doctors. Research groups have found that CFS occurred with the event of adverse mental stress, caused by Qi and blood deficiency, the mental disorder situation become its main pathological aspect. Liver stagnation and spleen deficiency is the main TCM differentiation, often accompanied by symptoms of mental emotions, as equal as "YU BING". The Chinese TCM professors haven't clarified TCM name of CFS. As the etiology and pathogenesis of theory and descriptions of the symptoms matched with TCM "YU BING", We research group clearly stated that CFS belong to "YU BING ", with the characteristics of "Fatigue and Yu ".In order to classify CFS and depression, anxiety disorder, study of Event-related Potentials (ERPs),BOLD-fMRI and three-Dimensional Magnetic Resonance Spectroscopy (MRS) are Introduced to explore the brain disorder aspects of cognitive dysfunction and frontal biochemical metabolic abnormalities for ＂Fatigue and Yu ",so as to be supporting central objective basis. As CFS has "fatigue \depression\anxiety" in common, the integrity introduction of experimental psychological methods and comprehensive analysis of fatigue and depression and anxiety rating scale are necessary to deeplyr explore the CFS relationship between the ＂Fatigue and Yu "and compared with findinds on brain imagines results,revealing the degree of relationship between the "Fatigue and Yu ", aiming for providing the scientific connotation and differentiation method for mental disorder situation on CFS.

以持久疲劳为主诉的慢性疲劳综合征(CFS)抑或是精神疾病、神经疾病或是躯体形式障碍一直是西医界争论的焦点，中医界亦未明确中医病名。课题组已发现CFS发生与不良精神应激事件有关，气血亏虚，情志不遂是其主要病理环节，肝郁脾虚为主要证型，常伴有精神情志症状，与 "郁病"的病因病机理论和症状描述一致。因此，课题组明确提出CFS属于"郁病"范畴，具有"疲郁同病"的特征。拟结合影像学BOLD-fMRI、MRS和ERPs等功能检查，研究CFS患者情绪加工处理、认知功能障碍及额叶生化代谢异常等方面的机制，为CFS归类中医郁病提供中枢性客观依据；针对CFS "疲劳-抑郁-焦虑"临床表现，综合运用疲劳-抑郁-焦虑等评定量表，对照中枢检查结果，进一步揭示"疲"与"郁"分层因素和相关关系，为CFS"疲郁同病"提供科学内涵,以期早期筛选出CFS情志疾患，为早期干预提供良好的临床鉴别手段。

项目背景：前期研究发现CFS发生具有“疲郁同病”的特征。故课题组拟结合影像学功能检查，研究CFS患者情绪加工处理、认知功能障碍及额叶生化代谢异常等方面的机制，为CFS归类中医郁病提供中枢性客观依据，为CFS“疲郁同病”提供科学内涵。.主要研究内容：对2014年1月至2017年12月，在上海岳阳医院就诊的符合本研究筛选标准的CFS患者、一般疲劳组及正常组各30例受试者进行血氧水平依赖fMRI、MRS、EPRs检测。结合量表的测定，观察躯体性疲劳、精神性疲劳之间的相关性。.重要结果：1.量表分析：①CFS组FS-14疲劳总分、躯体性疲劳及精神疲劳评分较正常组、一般疲劳组显著增高；②CFS组HAMD抑郁总分及各维度评分较其他两组显著升高；③CFS组HAMA焦虑总分、躯体性焦虑因子和精神性焦虑因子显著高于其他两组。2.相关性分析：CFS疲劳程度与抑郁评分呈中等强度正相关，与焦虑总分存在相关性。3.影像学检查：①BOLD-fMRI 提示CFS患者存在多个脑区的功能连接减弱；②CFS组的N2、P3靶潜伏期显著性延长及P3靶波幅的显著降低；③CFS患者存在双侧海马脑内NAA、Cho代谢异常。.关键数据：1.CFS组FS-14总分为10.77±1.57，HAMD总分15.97±6.37， HAMA总分12.10±5.14，有统计学差异。2. CFS疲劳程度FS-14总分与HAMD-24总分呈中等正相关（r=0.379），与HAMA总分呈正相关性(r=0.217)。3. CFS扣带回后部至右侧颞上回、右侧枕下回、右侧额上回、右侧楔前回、左侧扣带回后部、右侧颞中回t值较正常和一般疲劳组降低。4. CFS组患者N2靶潜伏期213.9±19.7ms，P3靶潜伏期323.9±24.4ms，P3靶波幅2.97±1.92 μV，有统计学差异。5. CFS组NAA/Cr左侧0.66±0.01分，右侧0.67±0.01分，Cho/Cr左侧1.06±0.01分，右侧1.06±0.01分，有统计学差异。.科学意义：“疲郁同病”是CFS的临床特征，CFS大脑多个脑区连接功能异常、事件相关电位延长、双侧海马区神经生化代谢产物紊乱，为CFS负性情绪中枢发病机制；BOLD-fMRI、ERPs及MRS影像学检查可为CFS临床诊断提供科学依据。

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