Adrenergic dysfunction in patients with myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia: A systematic review and meta-analysis.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL European Journal of Clinical Investigation Pub Date : 2024-09-25 DOI:10.1111/eci.14318

Jolien Hendrix, Lara Fanning, Arne Wyns, Ishtiaq Ahmed, Madhura Shekhar Patil, Emma Richter, Jente Van Campenhout, Kelly Ickmans, Rembert Mertens, Jo Nijs, Lode Godderis, Andrea Polli

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Abstract

Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and fibromyalgia (FM) are comorbid disorders with overlapping symptoms. Research highlights autonomic dysfunction compared to healthy individuals, particularly involving the sympathetic branch. While past reviews focused on neurophysiological assessments, this systematic review summarises biological adrenergic markers, offering deeper insights into the observed sympathetic dysfunction in ME/CFS and FM aiming to identify targetable pathophysiological mechanisms.

Methods: A systematic search was performed on PubMed, Web of Science, Embase and Scopus. Studies investigating peripheral biological markers of adrenergic function in patients with ME/CFS or FM compared to healthy controls at baseline were included. Meta-analyses were performed using R statistical software.

Results: This meta-analysis of 37 studies, encompassing 543 ME/CFS patients and 651 FM patients, compared with 747 and 447 healthy controls, respectively, revealed elevated adrenaline (SMD = .49 [.31-.67]; Z = 5.29, p < .01) and β1 adrenergic receptor expression (SMD = .79 [.06-1.52]; Z = 2.13; p = .03) in blood of ME/CFS patients at rest. Additionally, patients with ME/CFS had a greater increase in the expression of α2A adrenergic receptor (AR, SMD = .57 [.18-.97]; Z = 2.85, p < .01), β2 AR (SMD = .41 [.02-.81]; Z = 2.04; p = .04) and COMT (SMD = .42 [.03-.81]; Z = 2.11; p = .03) after exercise and an increased response of noradrenaline to an orthostatic test (SMD = .11 [-.47 to -.70]; Z = 2.10; p = .04), both found in blood. FM patients showed no significant differences at baseline but exhibited a diminished adrenaline response to exercise (SMD = -.79 [-1.27 to -.30]; Z = -3.14; p < .01).

Conclusion: This systematic review and meta-analysis revealed adrenergic dysfunction mainly in patients with ME/CFS. Higher baseline adrenaline levels and atypical responses to exercise in ME/CFS indicate that sympathetic dysfunction, underscored by adrenergic abnormalities, is more involved in the pathophysiology of ME/CFS rather than FM.

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肌痛性脑脊髓炎/慢性疲劳综合征和纤维肌痛患者的肾上腺素能功能障碍：系统回顾和荟萃分析。

背景：肌痛性脑脊髓炎/慢性疲劳综合征（ME/CFS）和纤维肌痛（FM）是症状重叠的合并症。与健康人相比，研究强调自律神经功能失调，尤其是涉及交感神经分支的自律神经功能失调。过去的综述侧重于神经生理学评估，而本系统性综述则总结了生物肾上腺素能标记物，对在 ME/CFS 和 FM 中观察到的交感神经功能障碍提供了更深入的见解，旨在确定可针对的病理生理机制：方法：在 PubMed、Web of Science、Embase 和 Scopus 上进行了系统检索。方法：在PubM、Web Science、Embase和Scopus上进行了系统搜索，纳入了调查ME/CFS或FM患者与基线健康对照组相比肾上腺素能功能的外周生物标志物的研究。使用R统计软件进行荟萃分析：该荟萃分析共纳入 37 项研究，包括 543 名 ME/CFS 患者和 651 名 FM 患者，分别与 747 名和 447 名健康对照者进行比较，结果显示肾上腺素升高（SMD = .49 [.31-.67]; Z = 5.29, p 结论：该荟萃分析发现，ME/CFS 患者和 FM 患者的肾上腺素功能与健康对照者存在显著差异：该系统综述和荟萃分析显示，肾上腺素功能障碍主要发生在 ME/CFS 患者身上。ME/CFS患者较高的肾上腺素基线水平和对运动的非典型反应表明，肾上腺素能异常所凸显的交感神经功能障碍在ME/CFS而非FM的病理生理学中占更大比重。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.