Stadje Rebekka, Dornieden Katharina, Baum Erika, Becker Annette, Biroga Tobias, Bösner Stefan, Haasenritter Jörg, Keunecke Christian, Viniol Annika, Donner-Banzhoff Norbert
Department of General Practice/Family Medicine, University of Marburg, Karl-von-Frisch-Str. 4, 35043, Marburg, Germany.
BMC Fam Pract. 2016 Oct 20;17(1):147. doi: 10.1186/s12875-016-0545-5.
Tiredness is one of the most frequent complaints in primary care. Although often self-limiting and frequently associated with psychosocial stress, patients but also their physicians are often uncertain regarding a serious cause and appropriate diagnostic work-up. We conducted a systematic review and meta-analysis of studies reporting on differential diagnosis of fatigue in primary care.
MEDLINE, EMBASE and conference abstracts were searched for primary care based studies of patients presenting with tiredness. Twenty-six studies were included. We report on anaemia, malignancy, serious organic disease, depression and the chronic fatigue syndrome (CFS) as causes of tiredness as presenting complaint.
We found considerable heterogeneity of estimates which was reduced by limiting our analysis to high quality studies. Prevalences were as follows-anaemia: 2.8 % (CI (confidence interval) 1.6-4.8 %); malignancy: 0.6 % (CI 0.3-1.3 %); serious somatic disease: 4.3 % (CI 2.7-6.7 %); depression 18.5 % (CI 16.2-21.0 %). Pooling was not appropriate for CFS. In studies with control groups of patients without the symptom of tiredness, prevalence of somatic disease was identical to those complaining of tiredness. Depression, however, was more frequent among those with tiredness.
Serious somatic disease is rare in patients complaining of tiredness. Since prevalence is similar in patients without tiredness, the association may not be causal. Extensive investigations are only warranted in case of specific findings from the history or clinical examination. Instead, attention should focus on depression and psychosocial problems.
疲劳是基层医疗中最常见的主诉之一。尽管疲劳通常具有自限性，且常常与心理社会压力相关，但患者及其医生往往不确定其是否存在严重病因以及合适的诊断检查方法。我们对有关基层医疗中疲劳鉴别诊断的研究进行了系统评价和荟萃分析。
检索MEDLINE、EMBASE和会议摘要，查找以基层医疗中出现疲劳症状的患者为基础的研究。纳入了26项研究。我们报告了贫血、恶性肿瘤、严重器质性疾病、抑郁症和慢性疲劳综合征（CFS）作为以疲劳为主诉的病因情况。
我们发现估计值存在相当大的异质性，通过将分析限制在高质量研究中，这种异质性有所降低。患病率如下：贫血：2.8%（置信区间[CI] 1.6 - 4.8%）；恶性肿瘤：0.6%（CI 0.3 - 1.3%）；严重躯体疾病：4.3%（CI 2.7 - 6.7%）；抑郁症：18.5%（CI 16.2 - 21.0%）。CFS不适合进行合并分析。在没有疲劳症状的患者作为对照组的研究中，躯体疾病的患病率与主诉疲劳的患者相同。然而，抑郁症在有疲劳症状的患者中更为常见。
主诉疲劳的患者中严重躯体疾病很少见。由于在无疲劳症状的患者中患病率相似，这种关联可能不是因果关系。只有在病史或临床检查有特定发现时才需要进行广泛检查。相反，应将注意力集中在抑郁症和心理社会问题上。
