卒中后疲劳的相关因素及干预策略

Related Factors and Intervention Strategies for Post-Stroke Fatigue

摘要: 卒中后疲劳(Post-stroke Fatigue, PSF)是卒中后最常见、最持久、最具致残性的并发症之一，其特征为早期疲惫、厌倦、缺乏精力以及不愿意主动进行活动，往往无法通过休息有所好转。PSF的发病机制可能与炎症反应、免疫失调、神经递质改变、全脑神经网络异常以及等位基因多态性有关，相关因素包括年龄、性别、脑白质病变、hs-CPR、HbA1c、Hcy、卒中后共患病、卒中前疲劳等，但不同研究中存在矛盾。目前诊断主要依赖主观量表，临床诊断率低，尚缺乏有效的治疗措施，个体差异较大。本综述将从相关因素、筛查和评估、管理及治疗等方面进行阐述，为临床提供参考。

Abstract: Post-stroke fatigue (PSF), one of the most prevalent, persistent, and debilitating complications following stroke, is characterized by persistent exhaustion, diminished energy levels, reduced motivation for activity, and unrelieved symptoms despite rest. Emerging evidence suggests that its pathogenesis may involve neuroinflammatory cascades, immune dysregulation, monoaminergic neurotransmitter dysregulation, large-scale neural network reorganization, and allelic polymorphisms. Identified risk factors include advanced age, sex differences, white matter hyperintensities, elevated high-sensitivity C-reactive protein (hs-CRP), hemoglobin A1c (HbA1c), homocysteine (Hcy) levels, post-stroke comorbidities, and pre-stroke fatigue, though divergent findings across studies warrant further validation. Current diagnostic reliance on subjective rating scales contributes to underdiagnosis in clinical practice, while therapeutic approaches remain limited and exhibit marked interindividual variability. This comprehensive review synthesizes current evidence on risk factor stratification, screening protocols, and multimodal management strategies, aiming to inform evidence-based clinical decision-making for PSF.