《洛杉磯時(shí)報(bào)》：慢性疲勞綜合癥之謎
Most health professionals have finally acknowledged that it's a real and serious illness. But we still don't know what causes it.
大多數(shù)健康專家最終承認(rèn)，這是一種確實(shí)而嚴(yán)重的疾病。但我們?nèi)匀徊恢朗鞘裁丛蛞鸬摹?b style="BACKGROUND: none transparent scroll repeat 0% 0%" class="label bg2" jquery1320559885953="58">
By Jay A. Levy and Daniel L. Peterson
作者：瑞.A.萊維和丹尼爾.L.彼得森
September 30, 2011
2011年9月30日
Some doctors are beginning to believe that there may not be one single cause of chronic fatigue syndrome but a number of causes that all produce the same disturbance in the immune system. (Los Angeles Times)
一些醫(yī)生開始認(rèn)為，慢性疲勞綜合癥的原因不是單個(gè)而是許多原因一起引起了免疫系統(tǒng)失調(diào)（《洛杉磯時(shí)報(bào)》）
For more than 100 years, medical literature has contained reports of a debilitating illness that causes prolonged fatigue, memory loss, headaches, cognitive problems and issues with digestion and sleep. Teddy Roosevelt, John Muir and Thomas Eakins all suffered from what was then known as neurasthenia.
一百多年以來(lái)，醫(yī)學(xué)文學(xué)涵蓋了一些使人非常虛弱的疾病的報(bào)道，那些疾病會(huì)引起人慢性疲勞、記憶喪失、頭痛、認(rèn)知問(wèn)題或者消化和睡眠問(wèn)題。泰迪·羅斯福、約翰·繆爾和湯姆·艾金斯都忍受了當(dāng)時(shí)被稱為神經(jīng)衰弱的折磨。
At that time, the recommended treatment for women was bed rest; men were advised to head to the Wild West. But neither treatment could be counted on to cure the disease.
當(dāng)時(shí)，給女性推薦的治療是臥床休息，而男性則建議去西部荒原。但是不管哪種治療對(duì)治神經(jīng)衰弱都沒(méi)有用。
Toward the end of the 20th century, doctors came up with the term chronic fatigue syndrome (or, in Europe, myalgic encephalomyelitis) to describe the set of symptoms that used to be called neurasthenia. But we still did not fully understand the illness, nor had we isolated its cause.
到20世紀(jì)末時(shí)，醫(yī)生們想出了慢性疲勞癥的術(shù)語(yǔ)（或者歐洲的肌痛性腦脊髓炎）來(lái)描述那一系列曾被成為神經(jīng)衰弱的癥狀。但是我們?nèi)匀徊皇呛苊靼走@種疾病，也沒(méi)有找出是何種原因引起的。
Patients have suffered because of this failure to fully understand the disease. Sometimes, doctors attributed the symptoms to anxiety, depression or hypochondria. Employers have been less than sympathetic.
病人因?yàn)榇朔N疾病沒(méi)有充分弄懂的失敗而飽受疾病的折磨，進(jìn)而充分了解了這種疾病。有時(shí)，醫(yī)生將癥狀歸于緊張、抑郁或者憂郁癥。雇主們都不夠有同情心。
Today, most health professionals have finally acknowledged that chronic fatigue syndrome is a real and serious illness. But its name, which focuses on just one of the disorder's many symptoms, has served to trivialize the condition, making it seem more psychological than physical and reducing interest in the disease among mainstream medical and scientific researchers.
現(xiàn)在，很多健康專家最終承認(rèn)，慢性疲勞是一種確實(shí)的嚴(yán)重疾病。但是它的名字只表現(xiàn)了許多失調(diào)癥狀的其中之一，因而小看了疾病的狀況，讓這種病看起來(lái)更多是精神上而非身體上，也降低了主流醫(yī)學(xué)和科學(xué)研究的研究興趣。
This low interest among researchers is unfortunate because most of the biggest unsolved problems with chronic fatigue syndrome are scientific ones. We need to learn what causes the illness and we need to use that information to develop tests to diagnose, prevent and treat it.
研究員稀少興趣令人遺憾，因?yàn)橐驗(yàn)槁云诰C合癥的尚未解決的絕大部分問(wèn)題是科學(xué)問(wèn)題。我們需要知道引起疾病的原因，然后用那些信息來(lái)開發(fā)診斷測(cè)試，預(yù)防和治療疾病。
The current consensus is that chronic fatigue syndrome is probably caused by a disturbance to the immune system. In ways that are not entirely clear, this disturbance upsets the immune system for a prolonged period of time and leads the body to become hyper-responsive and produce a large outpouring of toxic substances, which then cause the fatigue, muscle aches, headaches and mental confusion associated with the disease.
現(xiàn)在的共識(shí)是，慢性疲勞綜合癥可能是免疫系統(tǒng)干擾引起的。方法上還不是完全清楚，這種干擾持續(xù)地?cái)_亂免疫系統(tǒng)，讓身體過(guò)分敏感，產(chǎn)生出大量的有毒物質(zhì)，這些有毒物質(zhì)會(huì)引起疲勞、肌肉酸痛、頭痛和與疾病相關(guān)的精神錯(cuò)亂。
Scientists have speculated that the chain of events that leads to this prolonged immune disorder begins when someone is exposed to a triggering agent — a toxic chemical, for instance, or a bacterial or viral infection. But identifying such an agent has proved difficult.
科學(xué)家推測(cè)，當(dāng)某人接觸了一種觸發(fā)藥劑時(shí)——比如，一種有毒的化學(xué)藥品，或者細(xì)菌感染、病毒感染——一系列事件導(dǎo)致長(zhǎng)期免疫系統(tǒng)失調(diào)開始了。
One complication has been that by the time someone develops symptoms and seeks treatment, the underlying infection is no longer detectable, so there is no longer a way to identify the causative agent from blood tests.
這時(shí)候，情況復(fù)雜了，那人癥狀顯露，尋求治療方法，潛在的感染就不再覺(jué)察得到，所以就沒(méi)有一種方式能通過(guò)血液測(cè)試來(lái)識(shí)別病原體。
To complicate things even more, the over-responsive immune systems of people with chronic fatigue syndrome can activate co-infections, including Epstein-Barr virus, CMV and HHV-6, which make it even more difficult to identify the initial trigger.
甚至?xí)屖虑楦鼜?fù)雜，患有慢性疲勞綜合癥的人的過(guò)分敏感的免疫系統(tǒng)會(huì)刺激交互感染，引發(fā)包括巴爾病毒、巨細(xì)胞病毒和人皰疹病毒6型等病毒，這使得更難識(shí)別最初的觸發(fā)原因。
Some doctors are beginning to believe that there may not be one single cause of this syndrome but a number of causes that all produce the same disturbance in the immune system. But what those agents are and how they cause the disturbance are challenging questions.
一些醫(yī)生開始認(rèn)為，可能這種綜合征的原因不是單個(gè)而是一系列原因產(chǎn)生了免疫系統(tǒng)中的同種失調(diào)。但是到底是什么以及它們是怎樣造成失調(diào)的，還是富挑戰(zhàn)性的問(wèn)題。
In the last few decades a number of viruses and bacteria have been fingered as possible culprits for causing chronic fatigue syndrome, but none ultimately stood the test of scientific scrutiny. The most dramatic example came two years ago when a group of researchers reported finding a mouse-related virus called XMRV, a pathogen in the same family as HIV, which causes AIDS. They believed they had identified this virus in the blood of a several patients with chronic fatigue syndrome, raising the hopes of patients everywhere.
近幾十年，大量的細(xì)菌和病毒被認(rèn)為是引起慢性疲勞綜合征的可能罪魁禍?zhǔn)祝菦](méi)有一個(gè)最后能通過(guò)科學(xué)細(xì)查的測(cè)試。最明顯的是兩年前的那個(gè)例子，一堆研究員報(bào)告說(shuō)發(fā)現(xiàn)了一種和鼠相關(guān)的病毒，這病毒叫做異嗜性小鼠白血病病毒相關(guān)病毒 ，和引起艾滋的HIV病毒是同種病原體。他們認(rèn)為，他們是在患有慢性疲勞綜合癥的一些病人的血液中識(shí)別出這種病毒，這燃起了各地患者的希望。
Unfortunately, before this claim had been fully validated, many patients embraced XMRV as the long-sought cause of this illness and began considering potential treatments. Because of the similarities between the mouse virus and HIV, some of them even started taking AIDS drugs.
但遺憾的是，這項(xiàng)聲明充分驗(yàn)證之前，許多的病人相信異嗜性小鼠白血病病毒相關(guān)病毒正是長(zhǎng)期尋索的引起此種疾病的病因，開始考慮一些可能的治療。因?yàn)槭蟛《九cHIV病毒之間的很多相似性，一些病人甚至開始服用艾滋病藥物。
Then, we found out the truth.
然后，我們發(fā)現(xiàn)了真相。
In more than 10 follow-up studies, research in our UC San Francisco laboratories and elsewhere failed to find any evidence of XMRV in the blood of the chronic fatigue patients tested. Moreover, experiments indicated that this virus does not survive well in human blood, making it an unlikely source for a human infection. Other studies have suggested that the XMRV detected in the original studies may have come from contaminated lab materials.
在超過(guò)10個(gè)的后續(xù)研究中，我國(guó)UC舊金山實(shí)驗(yàn)室和其他實(shí)驗(yàn)室的研究沒(méi)有在被測(cè)的患有慢性疲勞綜合癥患者的血液里找到有異嗜性小鼠白血病病毒相關(guān)病毒（XMRV）的證據(jù)。另外，實(shí)驗(yàn)表明，這種病毒在人類血液中不能存活，也不可能引起人類感染。其他的研究也表明，在最初的研究中發(fā)現(xiàn)的異嗜性小鼠白血病病毒相關(guān)病毒（XMRV）可能是來(lái)自受污染的實(shí)驗(yàn)室材料。
So where does this leave the millions of people in the United States who suffer from chronic fatigue syndrome? Frustrated.
這將美國(guó)成千上萬(wàn)的患有慢性疾病綜合癥的人置于何處？當(dāng)然是失望沮喪中。
The medical community, and the agencies and foundations that fund medical research, have never given this illness the attention it deserves. That needs to change.
醫(yī)學(xué)界、代理機(jī)構(gòu)以及基金會(huì)資助醫(yī)學(xué)研究，給了這種疾病該有的而從未有過(guò)的關(guān)注。事情需要改變。
Some have suggested that a name change might help. Chronic fatigue immune dysfunction syndrome would be a more accurate name that would call attention to the fact that the disease is tied to a disturbed immune system.
一些人認(rèn)為換個(gè)名字可能有用。慢性疲勞癥候群可能是一個(gè)更準(zhǔn)確的名字，能引起對(duì)該疾病與干擾的免疫系統(tǒng)有關(guān)的事實(shí)的關(guān)注。
Next, we need to retrench, to reconsider the direction of research on this disease. We should embrace the fact that we still do not understand what causes it and that until we do, we will always be restricted in our ability to develop new ways of diagnosing, treating and preventing it. This will continue to be frustrating to patients and their families, but embracing science that is later disproved hasn't served sufferers well.
接下來(lái)，我們需要緊縮開支，重新考慮這個(gè)疾病的研究方向。我們應(yīng)該相信，我們?nèi)匀贿€不是很清楚引起的原因，我們應(yīng)該要做點(diǎn)什么，尋找診斷、治療和預(yù)防的新方法時(shí)會(huì)囿于自己的能力。我們還會(huì)繼續(xù)讓患者和他們的家人失望，相信科學(xué)隨后會(huì)被證明是錯(cuò)的不會(huì)讓患者好受。
Until we determine the causes and work out the best treatments for this debilitating condition, people with chronic fatigue syndrome will continue to suffer. In the meantime, we must increase support for basic research and for finding the best, evidence-based approaches for treating the disease.
慢性疲勞綜合癥患者仍會(huì)繼續(xù)受折磨，直到我們確定了這種虛弱病狀的病因，找出了最好的治療方法。同時(shí)，我們需要增加基本研究的支持，也需要找到最好的有根有據(jù)的方法去治療疾病。
Jay A. Levy is a professor of medicine and director of the UC San Francisco's Laboratory for Tumor and AIDS Virus Research. Daniel L. Peterson is a physician in private practice in Nevada and treats patients with chronic fatigue syndrome.
瑞.A.萊維是內(nèi)科教授，也是UC舊金山腫瘤和艾滋病病毒實(shí)驗(yàn)室的負(fù)責(zé)人。丹尼爾.L.彼得森是內(nèi)華達(dá)私人診所的內(nèi)科醫(yī)師，治療慢性疲勞綜合癥患者。
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