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Lancet Psychiatry：慢性疲劳综合征的康复治疗方法比较

2015-10-28 崔倩 译 MedSci原创

慢性疲劳综合征康复治疗
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PACE试验发现，慢性疲劳综合征患者随机分配1年后，在改善疲劳和身体机能方面，当添加到专科医疗护理（SMC），认知行为疗法（CBT），或分级运动疗法（GET）均优于自适应起搏治疗（APT）或SMC单独治疗。在此预先指定的随访研究中，该研究的目的是评估试验后获得了额外的治疗的效果，并研究长期结果（随机分配后至少2年），对那些原来包括在PACE试验原治疗组之间进行了比较。PACE试验是一项平行组随机对

PACE试验发现，慢性疲劳综合征患者随机分配1年后，在改善疲劳和身体机能方面，当添加到专科医疗护理（SMC）、认知行为疗法（CBT）、或分级运动疗法（GET）均优于自适应起搏治疗（APT）或SMC单独治疗。在此预先指定的随访研究中，该研究的目的是评估试验后获得了额外的治疗的效果，并研究长期结果（随机分配后至少2年），对那些原来包括在PACE试验原治疗组之间进行了比较。

PACE试验是一项平行组随机对照试验，参与的患者均是满足牛津标准的慢性疲劳综合征，他们来自于英国6个二级保健诊所，该试验在2005年3月18日和2008年11月28日之间进行。参与者被随机分配接受SMC单独治疗或加上APT、CBT、或GET治疗。主要成果为Chalder疲劳问卷调查得分，SF-36量表评分，在随机分组1年后进行评估。在这个长期的随访过程中，研究人员随机分组后至少2年后邮寄问卷调查来评估试验和结果。研究人员评估了最初随机组之间和组内的长期差异。

在2008年5月8日和2011年4月26日之间，来自PACE试验的481（75％）名参与者返回了调查问卷。从随机分配到返回长期随访评估的平均时间为31个月（IQR 30-32；范围24-53）。210（44％）名参与者接受了试验后进一步治疗（主要为CBT和GET）；原来分配接受SMC单独治疗（73/115[63%]）或APT治疗（60/119[50%]）的患者比那些原来分配给GET（41/127[32％]）或CBT（36/118[31％]；P<0.000）的参与者更有可能寻求治疗。疲劳和身体机能改善报告通过最初分配给CBT和GET参与者维持（疲劳和身体机能组内分别比较，长期随访与1年进行相比：CBT-2.2 [95％Cl为-3.7至-0.6]，3.3 [0.02至6.7]；GET 1.3 [-2.7至0.1]，0.5[2.7至3.6]）。在试验中，与1年时间相比，分配给APT和SMC单独治疗的参与者在整个随访时期都有所改善（疲劳和身体功能分别为：APT -3.0[-4.4至-1.6]，8.5 [4.5至12.5]；SMC -3.9 [-5.3〜-2.6]，7.1 [4.0至10.3]）。在长期随访过程中，随机治疗组之间结果差异不明显。

CBT和GET的有益效果在1年时就可以观察到，在随机分组后能够在平均2.5年的时间保持这种效果。SMC单独治疗或APT治疗在1年时有所改善，在长期随访中类似于CBT和GET，但这些数据应在根据医师的选择的其它疗法的上下文中以及1年试验结束评估后患者的偏好加以解释。未来的研究应确定对CBT和GET反应的影响因子，并为那些对上述疗法没有反应的患者开发新的更好的疗法。

原始出处：

Michael Sharpe,Kimberley A Goldsmith,Anthony L Johnson,et al.Rehabilitative treatments for chronic fatigue syndrome,Lancet Psychiatry,2015.10.27

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    2015-12-10 nian.wang1991

    #慢性疲劳综合征#

    0

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    2016-03-11 howi

    #Lancet#

    0

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    2015-11-07 diushouji

    #Psychiatry#

    0

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    2016-05-04 gous

    #方法比较#

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1670718, encodeId=892316e07184d, content=<a href='/topic/show?id=a2d1535e141' target=_blank style='color:#2F92EE;'>#慢性疲劳综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=41, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=53571, encryptionId=a2d1535e141, topicName=慢性疲劳综合征)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=9a6c26750549, createdName=nian.wang1991, createdTime=Thu Dec 10 22:25:00 CST 2015, time=2015-12-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1828279, encodeId=199d18282e9b5, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Mar 11 01:25:00 CST 2016, time=2016-03-11, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1791944, encodeId=c2c51e9194450, content=<a href='/topic/show?id=696a14818df' target=_blank style='color:#2F92EE;'>#Psychiatry#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=14818, encryptionId=696a14818df, topicName=Psychiatry)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c192448, createdName=diushouji, createdTime=Sat Nov 07 15:25:00 CST 2015, time=2015-11-07, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1744278, encodeId=8a2d1e442789c, content=<a href='/topic/show?id=d6df58e8151' target=_blank style='color:#2F92EE;'>#方法比较#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=36, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=58781, encryptionId=d6df58e8151, topicName=方法比较)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3f8535318348, createdName=gous, createdTime=Wed May 04 06:25:00 CST 2016, time=2016-05-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1260817, encodeId=351d126081e4e, content=<a href='/topic/show?id=493ee0559a7' target=_blank style='color:#2F92EE;'>#疲劳#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=70559, encryptionId=493ee0559a7, topicName=疲劳)], attachment=null, authenticateStatus=null, createdAvatar=/v1.0.0/img/user_icon.png, createdBy=674961, createdName=tamgche, createdTime=Fri Oct 30 08:25:00 CST 2015, time=2015-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1399188, encodeId=cdfb139918891, content=<a href='/topic/show?id=cac364650c0' target=_blank style='color:#2F92EE;'>#治疗方法#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=26, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=64650, encryptionId=cac364650c0, topicName=治疗方法)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=8cec2200006, createdName=showtest, createdTime=Fri Oct 30 08:25:00 CST 2015, time=2015-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1430556, encodeId=dafa1430556d5, content=<a href='/topic/show?id=f9b9e9124a8' target=_blank style='color:#2F92EE;'>#综合征#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79124, encryptionId=f9b9e9124a8, topicName=综合征)], attachment=null, authenticateStatus=null, createdAvatar=https://wx.qlogo.cn/mmopen/aLGWoFXAyMbIu3qymFOyheQLjPSX3OUs5GmkyBlcCOwTPIeq3why9NGibxxUqYo6hcx8qZLHZFgNPnBK1yzWeOFpyg2OnWOt0/0, createdBy=fa4716, createdName=zhouqu_8, createdTime=Fri Oct 30 08:25:00 CST 2015, time=2015-10-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=41851, encodeId=f98d41851f1, content=看看, beContent=null, objectType=article, channel=null, level=null, likeNumber=137, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://cacheapi.medsci.cn/resource/upload/20151021/IMG5627B03B7A49C7641.jpg, createdBy=cc6e1657094, createdName=风中云追忆, createdTime=Thu Oct 29 06:37:00 CST 2015, time=2015-10-29, status=1, ipAttribution=)]
    2015-10-30 tamgche

    #疲劳#

    0

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    2015-10-30 showtest

    #治疗方法#

    0

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    2015-10-30 zhouqu_8

    #综合征#

    0

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    2015-10-29 风中云追忆

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