疲乏是一种几乎在任何身体疾病中都会出现的症状。 围绕这个主题，讨论的差异性集中于出现疲乏症状的人群或以疲乏为唯一症状者。 还有一种状况也在讨论范畴，即疲乏并不一定是最初主诉，但却非常重要并使人逐渐衰弱。
定义
基于患者、医生、生物学家或心理学家的身份不同，疲乏有很多的定义和分类，反映了其解释的多样性。 常见且实用的定义为：疲乏为日常活动之中或之后的耗竭感或者开始日常活动时的精力不足感。[1]Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med. 1986 Jan;15(1):74-81.
http://www.ncbi.nlm.nih.gov/pubmed/3714661?tool=bestpractice.com
流行病学
乏力为一般人群的常见主诉，发生率为 4.3%-13.4%。[2]Hickie IB, Hooker AW, Hadzi-Pavlovic D, et al. Fatigue in selected primary care settings: sociodemographic and psychiatric correlates. Med J Aust. 1996 May 20;164(10):585-8.
http://www.ncbi.nlm.nih.gov/pubmed/8637460?tool=bestpractice.com
[3]Wessely S, Chalder T, Hirsch S, et al. The prevalence and morbidity of chronic fatigue and chronic fatigue syndrome: a prospective primary care study. Am J Public Health. 1997 Sep;87(9):1449-55.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1380968
http://www.ncbi.nlm.nih.gov/pubmed/9314795?tool=bestpractice.com
[4]Kroenke K, Wood DR, Mangelsdorff AD, et al. Chronic fatigue in primary care. Prevalence, patient characteristics, and outcome. JAMA. 1988 Aug 19;260(7):929-34.
http://www.ncbi.nlm.nih.gov/pubmed/3398197?tool=bestpractice.com
[5]Skapinakis P, Lewis G, Meltzer H. Clarifying the relationship between unexplained chronic fatigue and psychiatric morbidity: results from a community survey in Great Britain. Int Rev Psychiatry. 2003 Feb-May;15(1-2):57-64.
http://www.ncbi.nlm.nih.gov/pubmed/12745311?tool=bestpractice.com
[6]Steele L, Dobbins JG, Fukuda K, et al. The epidemiology of chronic fatigue in San Francisco. Am J Med. 1998 Sep 28;105(3A):83S-90S.
http://www.ncbi.nlm.nih.gov/pubmed/9790487?tool=bestpractice.com
[7]Galland-Decker C, Marques-Vidal P, Vollenweider P. Prevalence and factors associated with fatigue in the Lausanne middle-aged population: a population-based, cross-sectional survey. BMJ Open. 2019 Aug 24;9(8):e027070.
https://www.doi.org/10.1136/bmjopen-2018-027070
http://www.ncbi.nlm.nih.gov/pubmed/31446404?tool=bestpractice.com
在美国，在初级保健中的调查显示有11%到33%的患者有严重疲乏，引起每年近7 000 000次外科手术。
在初级卫生保健环境中，大多数因疲劳就诊的患者（至少三分之二）被诊断为内科或精神科疾病。[8]Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006 Jan 28;367(9507):346-55.
http://www.ncbi.nlm.nih.gov/pubmed/16443043?tool=bestpractice.com
[9]Wessely S, Chalder T, Hirsch S, et al. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Am J Psychiatry. 1996 Aug;153(8):1050-9.
http://www.ncbi.nlm.nih.gov/pubmed/8678174?tool=bestpractice.com
[10]Cathebras PJ, Robbins JM, Kirmayer LJ, et al. Fatigue in primary care: prevalence, psychiatric comorbidity, illness behavior, and outcome. J Gen Intern Med. 1992 May-Jun;7(3):276-86.
http://www.ncbi.nlm.nih.gov/pubmed/1613608?tool=bestpractice.com
[11]Okkes IM, Oskam SK, Lamberts H. The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. J Fam Pract. 2002 Jan;51(1):31-6.
http://www.ncbi.nlm.nih.gov/pubmed/11927060?tool=bestpractice.com
[12]Walker EA, Katon WJ, Jemelka RP. Psychiatric disorders and medical care utilization among people in the general population who report fatigue. J Gen Intern Med. 1993 Aug;8(8):436-40.
http://www.ncbi.nlm.nih.gov/pubmed/8410409?tool=bestpractice.com
荷兰的一项研究发现，在因任何时长的全身无力或疲乏而到全科医生处就诊的患者中，63% 有特定的诊断。[11]Okkes IM, Oskam SK, Lamberts H. The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. J Fam Pract. 2002 Jan;51(1):31-6.
http://www.ncbi.nlm.nih.gov/pubmed/11927060?tool=bestpractice.com
一项研究列举了最常见的诊断，按降序排列为病毒性疾病、上呼吸道感染、缺铁性贫血、急性支气管炎、适当剂量药品的不良反应以及抑郁或其他精神障碍。[13]Bates DW, Schmitt W, Buchwald D, et al. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Arch Intern Med. 1993 Dec 27;153(24):2759-65.
http://www.ncbi.nlm.nih.gov/pubmed/8257251?tool=bestpractice.com
最常见的精神疾病包括重性抑郁、惊恐障碍和躯体不适障碍。一项针对初级卫生机构内劳累鉴别诊断相关研究的系统评价和荟萃分析发现，严重躯体疾病是一种罕见原因。以下病因的患病率分别为：贫血（2.8%）；恶性肿瘤（0.6%）；严重躯体疾病（4.3%）；抑郁（18.5%）。[14]Stadje R, Dornieden K, Baum E, et al. The differential diagnosis of tiredness: a systematic review. BMC Fam Pract. 2016 Oct 20;17(1):147.
https://www.doi.org/10.1186/s12875-016-0545-5
http://www.ncbi.nlm.nih.gov/pubmed/27765009?tool=bestpractice.com
因为月经所致的缺铁和社会心理因素，女性比男性更多出现疲乏。[1]Chen MK. The epidemiology of self-perceived fatigue among adults. Prev Med. 1986 Jan;15(1):74-81.
http://www.ncbi.nlm.nih.gov/pubmed/3714661?tool=bestpractice.com
[6]Steele L, Dobbins JG, Fukuda K, et al. The epidemiology of chronic fatigue in San Francisco. Am J Med. 1998 Sep 28;105(3A):83S-90S.
http://www.ncbi.nlm.nih.gov/pubmed/9790487?tool=bestpractice.com
[7]Galland-Decker C, Marques-Vidal P, Vollenweider P. Prevalence and factors associated with fatigue in the Lausanne middle-aged population: a population-based, cross-sectional survey. BMJ Open. 2019 Aug 24;9(8):e027070.
https://www.doi.org/10.1136/bmjopen-2018-027070
http://www.ncbi.nlm.nih.gov/pubmed/31446404?tool=bestpractice.com
[15]Bensing JM, Hulsman RL, Schreurs KM. Gender differences in fatigue: biopsychosocial factors relating to fatigue in men and women. Med Care. 1999 Oct;37(10):1078-83.
http://www.ncbi.nlm.nih.gov/pubmed/10524374?tool=bestpractice.com
[16]Verdon F, Burnand B, Stubi CL, et al. Iron supplementation for unexplained fatigue in non-anaemic women: double blind randomised placebo controlled trial. BMJ. 2003 May 24;326(7399):1124.
http://www.bmj.com/cgi/content/full/326/7399/1124
http://www.ncbi.nlm.nih.gov/pubmed/12763985?tool=bestpractice.com
[17]Vaucher P, Druais PL, Waldvogel S, et al. Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ. 2012 Aug 7;184(11):1247-54.
http://www.ncbi.nlm.nih.gov/pubmed/22777991?tool=bestpractice.com
分类
根据起病、归因及症状持续时间，疲乏可以分为不同种类。疲劳可能源于：
可归因于：[8]Prins JB, van der Meer JW, Bleijenberg G. Chronic fatigue syndrome. Lancet. 2006 Jan 28;367(9507):346-55.
http://www.ncbi.nlm.nih.gov/pubmed/16443043?tool=bestpractice.com
症状持续时间可归分为：
近期疲劳（症状持续时间<1 个月）
长期疲劳（症状持续>1 个月）
慢性疲劳（症状持续>6 个月）
如原因未明，慢性疲乏在临床评估中常被划分为慢性疲劳综合征（也称为肌痛性脑脊髓炎 [ME]）和特发性慢性疲乏。[18]Fukuda K, Straus SE, Hickie I, et al. The chronic fatigue syndrome: a comprehensive approach to its definition and study. International Chronic Fatigue Syndrome Study Group. Ann Intern Med. 1994 Dec 15;121(12):953-9.
http://www.ncbi.nlm.nih.gov/pubmed/7978722?tool=bestpractice.com
[19]Reid S, Chalder T, Cleare A, et al. Chronic fatigue syndrome. BMJ. 2000 Jan 29;320(7230):292-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117488
http://www.ncbi.nlm.nih.gov/pubmed/10650029?tool=bestpractice.com
在报告真切存在慢性疲劳的患者中，慢性疲劳综合征占一小部分。即使在疲乏持续时间≥ 6 个月的患者中，慢性疲劳综合征的患病率也<40%。欧洲的一些研究显示疲劳感持续 6 个月以上的患者中多达 1/3 的病例被诊断为慢性疲劳综合征。[9]Wessely S, Chalder T, Hirsch S, et al. Psychological symptoms, somatic symptoms, and psychiatric disorder in chronic fatigue and chronic fatigue syndrome: a prospective study in the primary care setting. Am J Psychiatry. 1996 Aug;153(8):1050-9.
http://www.ncbi.nlm.nih.gov/pubmed/8678174?tool=bestpractice.com
[13]Bates DW, Schmitt W, Buchwald D, et al. Prevalence of fatigue and chronic fatigue syndrome in a primary care practice. Arch Intern Med. 1993 Dec 27;153(24):2759-65.
http://www.ncbi.nlm.nih.gov/pubmed/8257251?tool=bestpractice.com
[20]Buchwald D, Umali P, Umali J, et al. Chronic fatigue and the chronic fatigue syndrome: prevalence in a Pacific Northwest health care system. Ann Intern Med. 1995 Jul 15;123(2):81-8.
http://www.ncbi.nlm.nih.gov/pubmed/7778839?tool=bestpractice.com
[21]Darbishire L, Ridsdale L, Seed PT. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care. Br J Gen Pract. 2003 Jun;53(491):441-5.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1314617
http://www.ncbi.nlm.nih.gov/pubmed/12939888?tool=bestpractice.com
[22]Ridsdale L, Evans A, Jerrett W, et al. Patients with fatigue in general practice: a prospective study. BMJ. 1993 Jul 10;307(6896):103-6.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1693499
http://www.ncbi.nlm.nih.gov/pubmed/8343705?tool=bestpractice.com
美国国家医学院总结了与慢性疲劳综合征相关的几个关键症状，并且提议使用“系统性劳累不耐受疾病 (systemic exertion intolerance disease, SEID)”这一术语替代慢性疲劳综合征。[23]Institute of Medicine. Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, DC: The National Academies Press; 2015.
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