小结
定义
病史和体格检查
关键诊断因素
- 持续失能性疲劳
- 劳累后不适/疲劳 (PEM)、劳累性虚脱
- 短期记忆和/或集中力受损
- 咽痛
- 全身性关节痛，无炎症
- 发生于疲劳后的头痛/偏头痛
- 不能恢复精神的睡眠
- 体位性不耐受
- 弥散性肌肉、肌腱、筋膜和其他部位疼痛。
- 淋巴结触痛
其他诊断因素
- 发病年龄（青少年期和 30-50 岁）
- 流感样症状（不适、肌痛、发热）
- 眩晕{0}/{1}头晕
- 焦虑、情感障碍、非典型抑郁症
- 体温改变的感觉
- 劳累诱导性认知功能障碍（影响工作记忆，非持续性）
- 刺激物敏感
- 发热
危险因素
- 女性
- 青少年 EB 病毒感染
- 2019 冠状病毒病（COVID-19）
- ME/CFS 家族史阳性
- 遗传因素
- 成人特定传染病
- 自身免疫
- 肠道菌群
- 心理因素
- 严重抑郁障碍 (MDD)
- 血统
- 关节过度活动/松弛
诊断性检查
首要检查
- DePaul 症状问卷
- 全血细胞计数 (FBC) 与白细胞 (WBC) 分类计数
- 红细胞沉降率
- C 反应蛋白 (CRP)
- 综合代谢检查
- 甲状腺刺激激素
- 抗核抗体 (ANA)、类风湿因子
- HIV 抗体检测
需考虑的检查
- 如果存在有症状的直立不耐受，则进行直立倾斜试验；
- 血清铁蛋白水平
- HbA1c
- 尿毒物学筛查
- 针对麸质敏感/乳糜泻的抗体检测
新兴检查
- 2 天心肺运动试验
治疗流程
所有患者
撰稿人
作者
James N. Baraniuk, MD
Professor
Division of Rheumatology, Immunology, and Allergy
Georgetown University
Washington
DC
利益声明
JNB has received reimbursement for accommodation and airfare as a Visiting Professor from Griffith University, Menzies Institute, National Center for Emerging Diseases, Surfer's Paradise, Australia. He has received reimbursement for carrying out two PhD Thesis Evaluations at Griffith University. He has received a number of research grants as a consultant and/or collaborator with financial support as contracted through Georgetown University. He has been a member of the Center for Scientific Review Special Emphasis Panel for ME/CFS at the National Institutes of Health, the Department of Veterans Affairs' Health Services Research and Development Scientific Merit Review Board, and the Department of Defense Peer Reviewed Medical Research Program study section. He has served on a number of Advisory Boards (Department of Veterans Affairs, Research Advisory Committee on Persian Gulf War Illness), on one occasion with financial reimbursement. Non-reimbursed activities include a number of lectures on ME/CFS, a role as a lecturer at George Washington School of Public Health, Washington, DC. He is the author of a number of recent abstracts and presentations on ME/CFS/Gulf War Illness. JNB is the author of one reference cited in the topic.
鸣谢
Dr James N. Baraniuk would like to gratefully acknowledge Dr Craig N. Sawchuk and Dr Dedra Buchwald, previous contributors to this topic.
利益声明
CNS declares that he has no competing interests. DB is an author of a number of references cited in this topic. This topic was reviewed in 2018 by a patient with ME/CFS, and their feedback was considered as part of the topic update. The patient peer reviewer does not wish to be named.
同行评议者
Alastair Santhouse, MA (Cantab), MB, B.Chir, FRCP, FRCPsych
Consultant Psychiatrist in Psychological Medicine
South London and Maudsley NHS Foundation Trust
Denmark Hill
London
UK
利益声明
AS declares that he was a guideline development group member for NICE ME/CFS 2007 guidelines CG53.
Ben Z. Katz, MD
Professor of Pediatrics
Division of Infectious Diseases
Northwestern University Feinberg School of Medicine
Attending Physician
Ann & Robert H. Lurie Children’s Hospital of Chicago
Chicago
IL
利益声明
BZK declares that he has no competing interests.
Indre Bileviciute-Ljungar, MD, PhD
Associated Professor in Rehabilitation Medicine
Department of Clinical Sciences
Danderyd University Hospital
Karolinska Institutet
Stockholm
Sweden
利益声明
IB-L declares that he has no competing interests.
Tarek Gaber, MB, BCh, MSc, FRCP
Consultant Physician in Rehabilitation Medicine
Wrightington, Wigan and Leigh NHS Trust
Leigh Infirmary
Leigh
UK
利益声明
TG declares that he has no competing interests.
Malcolm Hooper, PhD, B Pharm, MRIC, C Chem
ME patient advocate
Emeritus Professor of Medicinal Chemistry
University of Sunderland
Sunderland
UK
利益声明
MH has lectured on ME and made national and international presentations to groups concerned with ME in Denmark, Sweden, Australia, US, and UK. He has acted as a witness for the GMC (UK) and received payment for this (travel and subsistence). He has also received payment from a family he supported in legal proceedings relating to vaccine damage, after the case was settled in their favour. He is a founder member of the Academy Of Nutritional Medicine, which has a special interest in Lyme disease. Their guidelines mention ME/CFS several times. He has given their keynote address for 3 years. He is the author of the paper Hooper M. Myalgic encephalomyelitis: a review with emphasis on key findings in biomedical research. J Clin Pathol. 2007;60:466-71. He is a member of the trustees for the John Richardson Research Group and the ME research group. He is also a trustee of European Services for People with Autism (ESPA) and a member of ESPA-Research, which is developing techniques to help with this condition. All of this work is voluntary.
鉴别诊断
- 冠状病毒病（COVID-19）
- 偏头痛
- 焦虑
更多 鉴别诊断指南
- 肌痛性脑脊髓炎（或脑病）/慢性疲劳综合征：诊断与管理
- 肌痛脑脊髓炎/慢性疲劳综合征：ME/CFS 的症状和诊断
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