森蘭

長久以來，對慢性疲勞症候群（Chronic fatigue syndrome）是否為法定疾病的爭議不斷，它更被藥廠所嚴重忽視，在近期則受到美國聯邦政府的關注。

受到最近一項科學發現所支持，研究結果將該病和可能的基因和生理病因作連結，CDC（美國疾病管制局）官員表示，要將慢性疲勞症候群納入「真正」的疾病之列。

CDC 局長Julie Gerberding醫師表示，疾病研究科學已有長足進展，她正著手進行活動宣導，以提高一般大眾和醫界對該病的重視。

Gerberding醫師表示，我們有責任提高這個病症變成真正疾病之認知。

為了在這方面努力，CDC同時也發佈簡明的指導方針，敦促醫師對有該病症狀的病患，在診斷時納入慢性疲勞症候群的考量，即使並沒有其他身體或心理方面的解釋被發現。

CDC的指導方針主張適量運動、飲食節制，並接受治療，以緩解個別的症狀，像是頭痛、喉嚨痛和睡眠問題。

【常見的問題】
有許多研究估計，在美國有約一百萬人深受該疾所苦，根據CDC表示，其中僅有少於20%的人被診斷出疾病。

慢性疲勞症候群的定義為：嚴重疲勞，並不會因休息而緩解，症狀持續六個月甚至更久，它更會使得病患處理例行日常活動的能力降低；其他的症狀包括肌肉和關節的疼痛、記憶力和專注力的問題、頭痛、愈睡愈累、喉嚨痛和淋巴結變脆弱。

慢性疲勞症候群已被認為是造成曠課（職）和工作生產力低落的最大原因，其所耗掉的社會成本高達數十億美金。

【難以確診】
然而，仍沒有實驗室測試、檢視或檢查能斷定出慢性疲勞症候群的各項詳細數據，目前診斷的方法是以病患過去的病史，以及對其他病症的排除後才下診斷。

而且目前慢性疲勞症候群尚無藥物可治，治療是將重點放在為症狀帶來部份緩解，以及正常功能的回復。

邁阿密大學慢性疲勞研究員Nancy Klimas醫師解釋醫界長期以來對該病所感到的挫折，她指出，截至目前，慢性疲勞症候群並無相關的診斷測試，也沒有血液檢測，這些病患並不好處置，且現今的醫療管理流程必須在六至九分鐘內完成疾病診斷，而這些病患不可能在這麼短的時間就被診斷出來，醫師需要花更多的時間來確診。

她補充道，照過去的經驗來看，此疾缺少診斷上的可信度，已經成為最大的絆腳石。

【為正名努力】
美國醫療史上，不乏不被視為「真正」疾病的範例，直至其生理上的病因被發現，才會被正名。

憂鬱症，長期以來被忽略並背負著污名，當研究員理解神經傳導物質的失衡才是真正的罪魁禍首，而非教養不好或個人不夠堅強等無理的原因，則很快的得到正式疾病名稱的認可。

現在，似乎慢性疲勞症候群正被權衡著是否要再作分級。

最近的科學發現已經將問題和身體的自體神經系統的異常作聯結，自體神經系統控制著血壓、心率和其他的功能。

同時，基因研究開始指出病患體內的基因，會導引著其身體對壓力過度反應，就某些人而言，重大的壓力源，像是創傷或重大感染，就會誘發形成慢性疲勞的過度反應。

CDC慢性病毒疾病部門主任William Reeves醫師表示，我並不是指好比公眾演說的一些小事情。

今年九月於《BMJ》發表的研究指出，患有嚴重感染的病患中，有12%在六個月後會有慢性疲勞症候群的發病狀況。

其他的研究則指出，慢性疲勞症候群是從某種過度反應免疫系統（hyper-reactive immune system）所造成的，過度反應免疫系統為易於激化，但難以抑制。

哈佛醫學院醫科教授Anthony Komaroff醫師表示，因為研究證據並非決定性的，那麼仍得對抗長期以來慢性疲勞症候群被認為是病患的胡思亂想，就我的觀點來看，那樣的爭論可以停止了。

【仍有謎題待解】
病因的理論，仍停在理論的階段。

Reeves醫師承認慢性疲勞症候群具高變異性，而且不太可能會只有一個簡單的病因來解釋；病因可能不只一個。

CDC希望醫界能瞭解如何去診斷慢性疲勞症候群，不過，Gerberding醫師表示，更重要的是，必須能確認並理解那難以置信的苦痛。

Chronic fatigue syndrome -- long doubted as a legitimate illness by many and largely ignored by the drug industry -- got a boost from the federal government today.

Buoyed by a spate of recent scientific findings tying the disorder to possible genetic and physiological causes, CDC officials said they want chronic fatigue syndrome to join the ranks of "real" diseases.

"The science has progressed," says Julie Gerberding, MD, director of the CDC, which today began a campaign to raise awareness of the disease among the general public and doctors.

"We are committed to improving awareness that this is a real disease," Gerberding says.

In this effort, the CDC also released brief guidelines pushing physicians to consider chronic fatigue syndrome in symptomatic patients when no other physical or psychiatric explanations can be found.

The guidelines urge the use of moderate exercise, diet modification, and medical treatment for relief of individual symptoms like headache, sore throat, and sleep problems.

Common Problem

Studies estimate as many as 1 million Americans suffer from the disease. Fewer than 20% of those with the disease have been diagnosed, according to the CDC.

Chronic fatigue syndrome is defined as severe fatigue -- not relieved with rest -- that lasts six months or longer, and reduces the patient's ability to do usual daily activities.

Other symptoms include pain in the muscles and joints, problems with memory and concentration, headaches, unrefreshing sleep, sore throat, and tender lymph nodes.

The disorder has been cited as a major cause of absenteeism and lost work productivity, with the cost running in the billions of dollars.

Hard to Pin Down

Still, there is still no lab test, scan, or examination that can reveal chronic fatigue syndrome. It is diagnosed by a patient's history of illness, and after eliminating other conditions.

Also, there is no drug to cure it. Treatment focuses on bringing some relief from symptoms and the return of normal function.

"There's no diagnostic test, no blood test," says Nancy Klimas, MD, a chronic fatigue researcher at the University of Miami, in explaining the medical community's long frustration with the disease. "These are hard patients, and medical management these days has to be done in six minutes, nine minutes -- and that's not going to happen with these patients. These patients slow your day down."

"Historically it's been the lack of credibility of this illness that's been the major stumbling block," she adds.

Fight for Legitimacy

American medical history is rife with examples of diseases not deemed "real" until their physical cause was found.

Depression, long ignored and stigmatized, quickly found legitimacy when researchers realized imbalanced neurotransmitters were more to blame than bad parenting or a lack of personal fortitude.

Now, it appears chronic fatigue syndrome is poised for such a graduation.

Recent scientific findings have linked the problem to abnormalities in the body's autonomic nervous system, which controls blood pressure, heart rate, and other functions.

Meanwhile, genomic studies are beginning to suggest that sufferers carry genes leading their bodies to overreact to stress. In such people, significant stressors like trauma or a major infection could trigger an overresponse that takes the form of chronic fatigue.

"I'm not talking about minor events like public speaking," says William Reeves, MD, director of the CDC's chronic viral diseases branch.

A study published in the BMJ in September found 12% of patients who had serious infections wound up with chronic fatigue symptoms six months later.

Other studies have suggested the illness stems from some kind of hyper-reactive immune system -- easily switched into action but hard to turn off.

While the evidence is not definitive, it goes against long-held notions that chronic fatigue syndrome is a figment of patients' imaginations, says Anthony Komaroff, MD, a professor of medicine at Harvard Medical School.

"In my view ? that debate should be over," he says.

Mysteries Remain

Still, theories about a cause remain theories.

Reeves acknowledges that chronic fatigue syndrome is highly variable and unlikely to come with a simple explanation. "There may be more than one."

The CDC wants physicians to understand how to diagnose chronic fatigue syndrome, Gerberding says, "but more importantly be able to validate and understand the incredible suffering."

SOURCES: Julie Gerberding, MD, director, CDC. Nancy Klimas, MD, University of Miami, Miami VA Medical Center. William Reeves, MD, director, chronic viral diseases branch, CDC. Hickie, I. BMJ, Sept.16, 2006; 333:575. Anthony Komaroff, MD, professor of medicine, Harvard Medical School.

WebMD Medical News
by Miranda Hitti

「慢性疲勞症候群」的定義非常嚴謹，必須具備持續達六個月以上無法因休息而緩解之不明原因的疲勞感，且要排除掉所有可能造成疲勞的慢性病因，疲勞的嚴重程度必須至少使日常活動力降至正常狀態的一半以上。

次要診斷標準包括：短暫的記憶力喪失或注意力不集中，造成活動能力受損；喉嚨疼痛；頸部或腋下淋巴結壓痛；肌肉疼痛；非發炎性關節疼痛；和以往的頭痛強度或模式不同的新發作頭痛；再怎麼睡都睡不飽；活動後疲倦超過24小時。以上症狀必須在至少六個月的疲勞中持續或反覆發作，且不能比疲勞早發生。