肌痛性脑脊髓炎(慢性疲劳综合征)

最后审阅: 28 四月 2022
最后更新: 19 一月 2022
19 Jan 2022

关于肌痛性脑脊髓炎/慢性疲劳综合征的最新英国指导

英国国家卫生与临床优化研究所(National Institute for Health and Care Excellence, NICE)更新了其关于肌痛性脑脊髓炎/慢性疲劳综合征 (encephalomyelitis/chronic fatigue syndrome, ME/CFS)诊断与管理的指南。相关建议包括:

  • 提高对何时应怀疑 ME/CFS 的警觉,以便患者得到更早诊断

  • 一旦怀疑 ME/CFS,就应立即对患者进行症状管理

  • 能量管理是支持 ME/CFS 患者应对 ME/CFS 症状的最重要工具之一

  • 强调尚无任何基于体力活动或运动的疗法能有效治愈 ME/CFS

  • 个体化睡眠管理建议

查看诊断:诊断路径

查看治疗:治疗路径

更新原始来源

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
更多 关键诊断因素

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
其他诊断因素

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
更多 危险因素

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
更多 首要检查

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
更多 需考虑的检查

新兴检查

  • 2 天心肺运动试验

治疗流程

持续性治疗

所有患者

撰稿人

作者

James N. Baraniuk, MD
James N. Baraniuk

Professor

Division of Rheumatology, Immunology, and Allergy

Georgetown University

Washington

DC

利益声明

JNB has received grants from the National Institute of Neurological Diseases and Stroke and the Department of Defense Congressionally Directed Medical Research Program. He has received travel reimbursement from the Iceland Medical Society for travel to the 2020 Iceland Medical Society meeting to give a presentation on CFS Veterans Affairs Research Advisory Committee for Gulf War Illness. JNB has purchased stocks for retirement plans that have no relationship to CFS or this 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
    更多 指南
  • 患者教育信息

    慢性疲劳综合征

    成人抑郁:是什么?

    更多 患者教育信息
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