疲劳的鉴别诊断:系统综述
发布时间：2018-08-09 20:25
【摘要】：背景疲劳是基层医疗中较为常见的患者主诉之一。虽然该疾病存在自我局限性,并且经常与心理社会压力相关联,但是对于其可能存在的严重病因和如何进行适当的诊断处理,患者及他们的医生经常不能确定。本文对基层医疗中疲劳鉴别诊断的相关研究进行了系统综述和荟萃分析。方法通过Medline、EMbase和会议摘要,检索有关基层医疗视角下患者出现疲劳的研究。共纳入26项研究。本文将作为疲劳病因的贫血、恶性肿瘤、严重器质性疾病、抑郁症和慢性疲劳综合征(CFS)视为目前主诉进行分析。结果贫血患病率为2.8%〔95%CI(1.6%,4.8%)〕;恶性肿瘤患病率为0.6%〔95%CI(0.3%,1.3%)〕;严重器质性疾病患病率为4.3%〔95%CI(2.7%,6.7%)〕;抑郁症患病率为18.5%〔95%CI(16.2%,21.0%)〕。CFS不适宜采用合并法。无疲劳症状患者躯体疾病的患病率与主诉疲劳患者的患病率相同;而主诉疲劳患者的抑郁症患病率高于无疲劳症状患者。结论严重的躯体疾病在主诉疲劳的患者中是罕见的,且由于其与无疲劳症状患者的患病率相似,所以二者间可能并不存在因果关系。只有在实验室检查中获得具体研究结论的情况下,广泛的调查才能够得到保证。否则,注意力应该集中在抑郁和心理社会问题上。
[Abstract]:Background fatigue is one of the most common complaints in primary care. Although the disease has self-limitations and is often associated with psycho-social stress, patients and their doctors are often uncertain as to the possible serious causes of the disease and how to properly diagnose and manage it. This paper makes a systematic review and meta-analysis on the related research of fatigue differential diagnosis in primary care. Methods through Medlinea EMbase and conference summary, we searched for the study of patient fatigue from the primary care perspective. A total of 26 studies were included. Anemia, malignant tumor, severe organic disease, depression and chronic fatigue syndrome (CFS) are regarded as the main cause of fatigue. Results the prevalence of anemia was 2.8% (95%CI: 1.6%,);: 0.6%) (95%CI (0.33%, 1.3%), the prevalence of serious organic diseases (95%CI) was 4.3% (95%CI (2.7%); depression was 18.5% (95%CI (16.2%) 21.0%). The prevalence rate of somatic diseases in patients with no fatigue symptoms was the same as that in patients with main complaints of fatigue, while the prevalence of depression in patients with major complaints of fatigue was higher than that in patients with no symptoms of fatigue. Conclusion severe somatic diseases are rare in patients who complain of fatigue, and there may not be a causal relationship between them because they are similar to those without fatigue symptoms. A broad investigation can only be ensured if specific findings are obtained in laboratory inspections. Otherwise, focus on depression and psychosocial problems.
【分类号】：R442.9
[Abstract]:Background fatigue is one of the most common complaints in primary care. Although the disease has self-limitations and is often associated with psycho-social stress, patients and their doctors are often uncertain as to the possible serious causes of the disease and how to properly diagnose and manage it. This paper makes a systematic review and meta-analysis on the related research of fatigue differential diagnosis in primary care. Methods through Medlinea EMbase and conference summary, we searched for the study of patient fatigue from the primary care perspective. A total of 26 studies were included. Anemia, malignant tumor, severe organic disease, depression and chronic fatigue syndrome (CFS) are regarded as the main cause of fatigue. Results the prevalence of anemia was 2.8% (95%CI: 1.6%,);: 0.6%) (95%CI (0.33%, 1.3%), the prevalence of serious organic diseases (95%CI) was 4.3% (95%CI (2.7%); depression was 18.5% (95%CI (16.2%) 21.0%). The prevalence rate of somatic diseases in patients with no fatigue symptoms was the same as that in patients with main complaints of fatigue, while the prevalence of depression in patients with major complaints of fatigue was higher than that in patients with no symptoms of fatigue. Conclusion severe somatic diseases are rare in patients who complain of fatigue, and there may not be a causal relationship between them because they are similar to those without fatigue symptoms. A broad investigation can only be ensured if specific findings are obtained in laboratory inspections. Otherwise, focus on depression and psychosocial problems.
【分类号】：R442.9
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