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Синдром хронічної втоми: взаємозв'язок вправ та імунної дисфункції

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Стаття
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22
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English
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medical condition that may explain the presence of chronic fatigue prohibits the diagnosis of CFS (diabetes, cancer, AIDS, etc.). Hence, all patients underwent an extensive medical evaluation, consisting of a standard physical examination, medical history, exercise capacity test, and routine laboratory tests. The laboratory tests included a complete blood cell count, determination of the erythrocyte sedimentation rate, serum electrolyte panel, measures of renal, hepatic, and thyroid function, and rheumatic and viral screens. If a patient's medical history did not exclude a psychiatric problem at the time of disease onset, then a structured psychiatric interview was performed. In a number of cases further neurological, gynecological, endocrine, cardiac, and/or gastrointestinal evaluations were performed. The medical records were also reviewed to determine whether patients suffered from organic or psychiatric illness that could explain their symptoms. If any of the laboratory/ additional analyzes revealed any active medical condition that may explain the presence of the patient's symptoms, the patient was excluded from the sample.

Exercise testing. The exercise tests were performed at a humidity of ±60% and at a room temperature of ±20°C (Klimakamer, Jaeger, Germany). The patients performed a bicycle ergometric test against a graded increase in workload until exhaustion was reached (2). The patients were asked to take a sitting position oh the electromagnetically braked ergometer (Lode B. V., Excalibur, Groningen, the Netherlands), after 3-5 min of adjustment the test was started. Heart rate was monitored continuously at rest and during exercise. There was continuous recording of the 12-lead electrocardiogram using an electrocardiograph (ECG Esaote Biomedica S. P. A., Firenze, Italy). To collect pulmonary data during the test, an open-circuit spirometer (Metamax Cortex, Biophysics, Germany) with automatic printout every 30 s was used. Automatically averages were attained for V02PEAK (peak oxygen uptake) and maximal carbon dioxide production during every 30-s interval for the duration of each stage of the exercise. A two-way breathing valve attached to a mask, which covered the patients' nose and mouth, was used to collect the expired air. The air was analyzed continuously for ventilatory and metabolic variables. Before each test, the spirometer was calibrated for environmental conditions. For the assessment of blood lactate concentration during the exercise stress test, blood was drawn every 2 min from an anticubital vein using natrium-heparinized capillaries (EKF Diagnostics, Germany). Twen-ty-microliter blood samples only for lactate determination were taken at the hyperaemized earlobe and assayed by ESAT 6660 lactate (Medingen GmbH, Germany). All patients started the test at 10 W, with an increase of 10 W-min-1 (2). To avoid early onset of fatigue in the lower extremities due to inadequate physical fitness, the duration of the exercise was kept below 15 min. Patients were instructed to bicycle at a constant speed of 70 rpm. The following variables were measured: heart rate at rest (HRREST), peak heart rate (HRPEAK), exercise duration, maximal work capacity attained, work capacity attained at a respiratory exchange ratio (RER) of 1. 0, V02PEAK per kilogram of body weight, body weight-adjusted oxygen uptake at RER = 1. 0, resting and peak RER (RERPEAK), the percentage of target heart rate achieved, and both the resting and peak lactate concentrations. The age-predicted HRPFAK was calculated as 220 minus the patients' age in years. The metabolic data analyzed were the means of the last 30 s from the final stage of exercise or the highest value attained if a decline in V02 occurred at the final workload (2). For estimating the peak workload, the following equation was used: (workload of the highest fully completed stage) + (number of seconds achieved during the final stage/60 X 10). Exercise performance testing is widely used for the assessment of patients with CFS, and it appears to be both reproducible and valid (15). The exercise testing protocol used in the present study was able to distinguish between female CFS patients and healthy sedentary females (2), and the exercise performance data obtained with this protocol correlated with activity limitations/participation restrictions in CFS patients (20).
RNase L-ratio determination. The assay is performed by 1) preparation of a cytoplasmic extract of the patient's peripheral mononuclear blood cells, 2) combination of this extract with a labeled probe that binds specifically to 2'-5' A binding proteins such as RNase L and the low molecular weight species, 3) sodium dodecylsulfate polyacrylamide gel electrophoresis, and 4) densitometry to determine the relative quantities of 2'-5' A binding proteins. The RNase L-ratio was counted using the following equation: RNase L-ratio = [low molecular weight RNase L]/[high molecular weight RNase L] X 10. In detail, peripheral mononuclear blood cells (PBMC) were separated from heparinized blood (30 mL) by Ficoll-Hypaque density gradient centrifugation within 4 h of phlebotomy. In addition, PBMC were stored at -70°C until cytoplasmic extraction preparation. The latter was performed in the presence of protease inhibitors elastase inhibitor III (Calbiochem, San Diego,
Фото Капча