傳染性單核球過多症可能會增加青少年慢性疲勞症的風險


  July 10, 2009 —根據發表於7月份小兒科期刊的一篇前溯研究結果,傳染性單核球過多症(Infectious mononucleosis,IM)可能會增加青少年慢性疲勞症(chronic fatigue syndrome,CFS)的風險。
  
  伊利諾州芝加哥西北大學Feinberg醫學院與兒童紀念醫院的Ben Z. Katz醫師等人寫道,觀察發現,青少年特別會在IM之後發生CFS;約有四分之三的CFS青少年,慢性疲勞之前有急性、單核球過多症類疾病,將近半數在症狀發生時有急性單核球過多感染症。
  
  研究目標是評估在IM之後兩年期間,青少年發生CFS的過程與結果。IM之後6個月,301名年紀在12至18歲的青少年接受電話篩選訪問。那些顯示未恢復者接受醫療評估,且在IM之後第12和24個月接受追蹤篩選評估。藉由已經建立的小兒科準則和未知對象回顧,研究者在第6、12和24個月時進行最後診斷。
  
  IM之後6個月,13%的青少年符合CFS準則,12個月時為7%,24個月時為4%。隨著時間過去,多數的青少年恢復。24個月時有CFS的其中2名青少年,在12個月時似乎有恢復或者可以有CFS的解釋,在24個月時再度分類為有CFS。
  
  在IM之後24個月,有CFS的13名青少年全都是女孩。相較於那些24個月時沒有CFS者,她們在12個月時的疲勞程度比較嚴重。IM急性期的皮質類固醇治療與發生CFS的風險增加無關。
  
  研究作者寫道,傳染性單核球過多症可能是青少年慢性疲勞症的風險因素之一。女性與疲勞程度較嚴重者,與青少年發生慢性疲勞症候群有關,而非急性期使用類固醇者。需要更多研究以確認傳染性單核球過多症之後持續疲勞的其他預測因素。
  
  國家孩童健康與人類發展研究中心支持本研究。研究作者宣告沒有相關財務關係。
  

Infectious Mononucleosis May Increase Risk for Chronic Fatigue Syndrome in Teens

By Laurie Barclay, MD
Medscape Medical News

July 10, 2009 — Infectious mononucleosis (IM) may be a risk factor for chronic fatigue syndrome (CFS) in adolescents, according to the results of a prospective study reported in the July issue of Pediatrics.

"The observation that CFS may follow IM occurs particularly frequently in adolescent samples," write Ben Z. Katz, MD, from Northwestern University Feinberg School of Medicine and Children's Memorial Hospital in Chicago, Illinois, and colleagues. "Acute, mononucleosis-like illnesses preceding chronic fatigue have been documented for approximately three fourths of adolescents with CFS, with nearly one half exhibiting active mononucleosis infection at symptom onset."

The objective of this study was to assess the course and outcome of CFS in adolescents during a 2-year period after IM. Six months after IM, 301 adolescents aged 12 to 18 years underwent a telephone screening interview. Those who appeared not to have recovered underwent a medical evaluation and also had follow-up screening 12 and 24 months after IM. Using established pediatric criteria and blinded review, the investigators made final diagnoses of CFS at 6, 12, and 24 months.

Criteria for CFS were met by 13% of adolescents at 6 months after IM, by 7% at 12 months, and by 4% at 24 months. With time, most adolescents recovered. Only 2 adolescents with CFS at 24 months seemed to have recovered or had an explanation for CFS at 12 months but then were reclassified as having CFS at 24 months.

All 13 adolescents who had CFS 24 months after IM were girls. Compared with those who did not have CFS at 24 months, they reported greater fatigue severity at 12 months. Corticosteroid treatment during the acute phase of IM was not associated with an increased risk for the development of CFS.

"Infectious mononucleosis may be a risk factor for chronic fatigue syndrome in adolescents," the study authors write. "Female gender and greater fatigue severity, but not reported steroid use during the acute illness, were associated with the development of chronic fatigue syndrome in adolescents. Additional research is needed to determine other predictors of persistent fatigue after infectious mononucleosis."

The National Institute of Child Health and Human Development supported this study. The study authors have disclosed no relevant financial relationships.

Pediatrics. 2009;124:189-193.

    



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