卒中后疲劳危险因素的系统评价

Risk Factors of Post-stroke Fatigue: a Systematic Review

目的系统评价卒中后疲劳危险因素,为卒中后疲劳的防治及健康教育提供参考依据。方法计算机检索The Cochrane Library、PubMed、Web of SCIence、EMbase、CNKI、WanFang Data和VIP数据库,搜集有关卒中后疲劳相关危险因素的病例-对照研究、队列研究、横断面研究,检索时限均为建库至2019年10月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用RevMan5.3进行Meta分析。结果共纳入14项研究,包括3201例患者。M e t a分析结果显示:卒中前疲劳(O R 5.93,95%CI 3.41~10.32,P<0.001)、抑郁症(OR 2.48,95%CI 1.83~3.36,P<0.001)、女性(OR 1.67,95%CI 1.24~2.26,P<0.001)、家庭功能障碍(OR 2.57,95%CI 1.86~3.57,P<0.001)、mRS评分(OR 2.65,95%CI 2.04~3.45,P<0.001)、冠心病(OR 3.41,95%CI 1.97~5.90,P<0.001)、不能自理(OR 4.32,95%CI 2.47~7.54,P<0.001)、高脂血症(OR 2.27,95%CI 1.20,4.27,P=0.01)、镇静药物使用(OR 4.10,95%CI 2.14~7.87,P<0.001)是卒中后疲劳的危险因素;卒中前规律运动(OR 0.50,95%CI 0.36~0.70,P<0.001)是卒中后疲劳的保护因素。结论本研究结果显示,性别(女性)、卒中前疲劳、抑郁、家庭功能障碍、mRS评分、冠心病、自理能力差、高脂血症、镇静药物使用可能是卒中后疲劳的危险因素,其余风险因素相关性有待进一步研究。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective To systematically review the risk factors associated with post-stroke fatigue(PSF),and to provide reference for the prevention and treatment of PSF and health education.Methods The Cochrane Library,PubMed,web of science,EMBASE,CNKI,Wanfang Data and VIP databases were electronically searched for case-control study,cohort study and cross-sectional study on the risk factors related to PSF.The retrieval time was from the establishment of the database to October 30,2019.Two reviewers independently screened literature,extracted data and evaluated the risk of bias of included studies.Meta-analysis was performed by using RevMan 5.3 software.Results A total of 14 studies were involved,including 3201 patients.The results of meta analysis showed:pre-stroke fatigue(OR 5.93,95%CI 3.41-10.32,P<0.001),depression(OR 2.48,95%CI 1.83-3.36,P<0.001),women(OR 1.67,95%CI 1.24-2.26,P<0.001),family dysfunction(OR 2.57,95%CI 1.86-3.57,P<0.001),mRS score(OR 2.65,95%CI 2.04-3.45,P<0.001],coronary heart disease(OR 3.41,95%CI 1.97-5.90,P<0.001),inability to take care of oneself(OR 4.32,95%CI 2.47-7.54,P<0.001),hyperlipidemia(OR 2.27,95%CI 1.20-4.27,P=0.01),sedative use(OR 4.10,95%CI 2.14-7.87,P<0.001)may be the risk factors of PSF;regular pre-stroke exercise(OR 0.50,95%CI 0.36-0.70,P<0.001)may be the protective factor of PSF.However,age,anxiety,diabetes and sleep disorders may be not correlated with PSF.Conclusions Current evidence shows that gender(female),pre-stroke fatigue,depression,family dysfunction,mRS score,coronary heart disease,poor self-care ability,hyperlipidemia,sedative use may be risk factors of post-stroke fatigue,while other related risk factors need to be further validated.Due to the limited quality and quantity of included studies,more high quality studies are needed to verify the above conclusions.