Sindrom kronične utrujenosti: Razlika med redakcijama

| treatment = [[simptomatsko zdravljenje|simptomatsko]]<ref name=CDC2020treat/><ref name=Coch2019Oct2>{{Cite web|title=Publication of Cochrane Review: 'Exercise therapy for chronic fatigue syndrome'|url=https://www.cochrane.org/news/publication-cochrane-review-exercise-therapy-chronic-fatigue-syndrome|last=Cochrane|author-linkwork=Cochrane (organisation)|date=21. 5. 2020|website=www.cochrane.org|language=en|access-date=24. 5. 2020|quote=It now places more emphasis on the limited applicability of the evidence to definitions of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) used in the included studies, the long-term effects of exercise on symptoms of fatigue, and acknowledges the limitations of the evidence about harms that may occur.}}</ref>

Vzrok ni pojasnjen, obstajajo pa različni predlagani biološki, genetski, infekcijski, fizikalni in psihološki mehanizmi vpliva na [[biokemija|biokemične]] procese v telesu, ki privedejo do sindroma kronične utrujenosti.<ref name="CDC-causes-2020">{{cite web |title=Possible Causes {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC |url=https://www.cdc.gov/me-cfs/about/possible-causes.html |website=www.cdc.gov |access-date=20. 5. 2020 |language=en-us |date=15. 5. 2019}}</ref><ref name=Af2003>{{cite journal | vauthorsauthor1 = Afari N, |author2=Buchwald D | title = Chronic fatigue syndrome: a review | journal = The American Journal of Psychiatry | volume = 160 | issue = 2 | pages = 221–236 | date = februar 2003 | pmid = 12562565 | doi = 10.1176/appi.ajp.160.2.221 }}</ref> Za potrditev diagnoze ni na voljo nobenega [[diagnostični test|diagnostičnega testa]] in diagnoza temelji le na bolnikovi simptomatiki.<ref name="Estévez-López 2020"/>

Utrujenost, ki je značilna za sindrom kronične utrujenosti, ni posledica večjega napora in se znatno ne izboljša s počitkom, prav tako pa ni posledica kakšne druge, predhodne bolezni.<ref name="CDCsym2020" /> Utrujenost je pogost simptom številnih bolezni, vendar pa je posebnost utrujenosti kot simptoma sindroma kronične utrujenosti nepojasnjenost nastanka ter prisotnost funkcionalne motnje.<ref name=Ran2005>{{cite journal | vauthorsauthor = Ranjith G | title = Epidemiology of chronic fatigue syndrome | journal = Occupational Medicine | volume = 55 | issue = 1 | pages = 13–19 | date = januar 2005 | pmid = 15699086 | doi = 10.1093/occmed/kqi012 | doi-access = free }}</ref>

Sindrom kronične utrujenosti ima okoli 1 % vseh bolnikov, ki so v oskrbi družinskih zdravnikov. Ocene o [[pojavnost]]i sindroma se zelo razlikujejo, saj različne [[epidemiološka študija|epidemiološke študije]] različno opredeljujejo bolezen.<ref name=Lim2020/><ref name="Estévez-López 2020">{{cite journal | last1=Estévez-López | first1=Fernando | last2=Mudie | first2=Kathleen | last3=Wang-Steverding | first3=Xia | last4=Bakken | first4=Inger Johanne | last5=Ivanovs | first5=Andrejs | last6=Castro-Marrero | first6=Jesús | last7=Nacul | first7=Luis | last8=Alegre | first8=Jose | last9=Zalewski | first9=Paweł | last10=Słomko | first10=Joanna | last11=Strand | first11=Elin Bolle | last12=Pheby | first12=Derek | last13=Shikova | first13=Evelina | last14=Lorusso | first14=Lorenzo | last15=Capelli | first15=Enrica | last16=Sekulic | first16=Slobodan | last17=Scheibenbogen | first17=Carmen | last18=Sepúlveda | first18=Nuno | last19=Murovska | first19=Modra | last20=Lacerda | first20=Eliana | title=Systematic Review of the Epidemiological Burden of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Across Europe: Current Evidence and EUROMENE Research Recommendations for Epidemiology | journal= Journal of Clinical Medicine| publisher=MDPI AG | volume=9 | issue=5 | date=21. 5. 2020 | issn=2077-0383 | pmid=32455633 | pmc=7290765 | doi=10.3390/jcm9051557 | page=1557}}</ref><ref name=SandlerLloyd2020/> V svetovnem merilu naj bi okoli 0,68–1 % prebivalstva v življenju zbolelo za sindromom kronične utrujenosti.<ref name=SandlerLloyd2020/><ref name=Lim2020/> Približno 1,5- do 2-krat pogosteje se pojavlja pri ženskah.<ref name=Lim2020>{{cite journal |vauthorsauthor1=Lim EJ, |author2=Ahn YC, |author3=Jang ES, |author4=Lee SW, |author5=Lee SH, |author6=Son CG |title=Systematic review and meta-analysis of the prevalence of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) |journal=J Transl Med |volume=18 |issue=1 |pages=100 |date=februar 2020 |pmid=32093722 |pmc=7038594 |doi=10.1186/s12967-020-02269-0 }}</ref> Najpogosteje prizadene odrasle v starosti od 40 do 60 let,<ref name=CDCEpide2018/> vendar se lahko pojavi kadarkoli v življenju, tudi v otroštvu.<ref name=CDC2020children>{{Cite web|title=ME/CFS in Children {{!}} Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) {{!}} CDC|url=https://www.cdc.gov/me-cfs/me-cfs-children/index.html | date=15. 5. 2019|website=www.cdc.gov|language=en-us|access-date=24. 5. 2020|quote=ME/CFS is often thought of as a problem in adults, but children (both adolescents and younger children) can also get ME/CFS.}}</ref>

Vzrok sindroma ni pojasnjen.<ref name=Un2016>{{cite journal | vauthors author1= Unger ER, |author2=Lin JS, |author3=Brimmer DJ, |author4=Lapp CW, |author5=Komaroff AL, |author6=Nath A, |author7=Laird S, |author8=Iskander J | title = CDC Grand Rounds: Chronic Fatigue Syndrome - Advancing Research and Clinical Education | journal = MMWR. Morbidity and Mortality Weekly Report | volume = 65 | issue = 50–51 | pages = 1434–1438 | date = december 2016 | pmid = 28033311 | doi = 10.15585/mmwr.mm655051a4 | doi-access = free }}</ref> Verjetno gre za preplet genskih, fizioloških in psiholoških dejavnikov.<ref name=Af2003 />

Pogosto se začne nenadno, kot [[gripa|gripi]] podobna bolezen in tudi zato so predlagali razne [[povzročitelj]]e okužb ([[mononukleoza]], okužba s ''[[Chlamydophila pneumoniae]]'', [[človeški herpesvirus 6]], [[lymska bolezen]]) kot vzrok sindromu kronične utrujenosti, vendar za nobenega ni dovolj dokazov.<ref name="Rosa2018">{{cite journal |vauthorsauthor1=Rasa S, |author2=Nora-Krukle Z, |author3=Henning N, |author4=Eliassen E, |author5=Shikova E, |author6=Harrer T, |author7=Scheibenbogen C, |author8=Murovska M, |author9=Prusty BK |title=Chronic viral infections in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) |journal=J Transl Med |volume=16 |issue=1 |pages=268 |date=oktober 2018 |pmid=30285773 |pmc=6167797 |doi=10.1186/s12967-018-1644-y }}</ref><ref name="IOM2015" /> Prisotno je lahko tudi [[vnetje]] v telesu.<ref>{{cite journal | vauthors author1= Gerwyn M, |author2=Maes M | s2cid = 11823204 | title = Mechanisms Explaining Muscle Fatigue and Muscle Pain in Patients with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a Review of Recent Findings | journal = Current Rheumatology Reports | volume = 19 | issue = 1 | pages = 1 | date = januar 2017 | pmid = 28116577 | doi = 10.1007/s11926-017-0628-x }}</ref> Pogosto sindrom kronične utrujenosti sledi virusni okužbi, kot sta mononukleoza ali [[virusni gastroenteritis]].<ref>{{cite web | url=https://www.southerncross.co.nz/group/medical-library/chronic-fatigue-syndrome-tapanui-flu | title=Chronic fatigue syndrome (Tapanui flu) - Southern Cross NZ}}</ref>

Vloga psiholoških dejavnikov v nastanku bolezni ni jasna.<ref name=Prins2006>{{cite journal |authorauthor1=Prins JB, |author2=van der Meer JW, |author3=Bleijenberg G |title=Chronic fatigue syndrome |journal=Lancet |volume=367|issue=9507 |pages=346–355 |year=2006 |pmid=16443043 |doi=10.1016/S0140-6736(06)68073-2}}</ref> Nekateri bolniki povsem zavračajo možnost psihološkega vzroka in pripisujejo bolezen povsem fizičnim vzrokom.<ref name=Cho2005>{{cite journal | author author1= Cho HJ, |author2=Hotopf M, |author3=Wessely S | title = The placebo response in the treatment of chronic fatigue syndrome: a systematic fatigue syndrome (CFS) or myalgic encephalomyelitis (ME) | journal = Psychosom Med | volume = 67 | issue = 2 | pages = 301–13| publisher = | year = 2005 | pmid =15784798| url = http://www.psychosomaticmedicine.org/cgi/content/full/67/2/301 | accessdate = 12. 12. 2008 | doi = 10.1097/01.psy.0000156969.76986.e0}}</ref> CDC opredeljuje SKU kot telesno bolezen<ref>{{Cite web|url=https://www.cdc.gov/me-cfs/healthcare-providers/presentation-clinical-course/etiology-pathophysiology.html|title=Myalgic Encephalomyelitis/Chronic Fatigue Syndrome&nbsp;— Etiology and Pathophysiology | date=10. 7. 2018}}</ref> in tudi glede na razvrstitev bolezni Svetovne zdravstvene organizacije ([[ICD-11]]) je uvrščena med nevrološke bolezni.<ref name="ICD-11">{{cite web | title=Mortality and Morbidity Statistics | website=ICD-11 | url=https://icd.who.int/browse11/l-m/en#/http://id.who.int/icd/entity/569175314 | access-date=9. 1. 2021}}</ref>

Med drugimi dejavniki tveganja so [[psihološki stres]], [[travma]] v otroštvu, perfekcionistična osebnost, starost, nizka stopnja izobrazbe, predhodna duševna bolezen ter [[alergija|alergije]]. Na osnovi tega nekateri menijo, da so vzrok sindromu kronične utrujenosti stresni odzivi notranjih organov.<ref>{{cite journal | vauthors author1= Van Houdenhove B, |author2=Kempke S, |author3=Luyten P | s2cid = 19669971 | title = Psychiatric aspects of chronic fatigue syndrome and fibromyalgia | journal = Current Psychiatry Reports | volume = 12 | issue = 3 | pages = 208–14 | date = JuneJunij 2010 | pmid = 20425282 | doi = 10.1007/s11920-010-0105-y }}</ref><ref name="PMID_17892624">{{cite journal | vauthors author1= Hempel S, |author2=Chambers D, |author3=Bagnall AM, |author4=Forbes C | title = Risk factors for chronic fatigue syndrome/myalgic encephalomyelitis: a systematic scoping review of multiple predictor studies | journal = Psychological Medicine | volume = 38 | issue = 7 | pages = 915–926 | date = julij 2008 | pmid = 17892624 | doi = 10.1017/S0033291707001602 }}</ref>

Na voljo ni specifičnih odobrenih zdravil ali drugih oblik zdravljenja,<ref name=CDC2020treat /><ref name=NICECG53>{{cite book |publisher= [[National Institute for Health and Clinical Excellence]] |title= Guideline 53: Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) |location= London |year= 2007 |isbn= 978-1-84629-453-2 |url= http://guidance.nice.org.uk/CG53}}</ref> so pa preskušali učinkovitost različnih zdravil in raziskave še vedno potekajo.<ref>{{cite journal | vauthors author1= Smith ME, |author2=Nelson HD, |author3=Haney E, |author4=Pappas M, |author5=Daeges M, |author6=Wasson N, |author7=McDonagh M | title = Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | journal = Evidence Report/Technology Assessment | issue = 219 | pages = 1–433 | date = december 2014 | pmid = 30313001 | doi = 10.23970/AHRQEPCERTA219 | url = https://www.ncbi.nlm.nih.gov/books/NBK293923/#_fm_s15_ | access-date = 22. 1. 2016 | publisher = Agency for Healthcare Research and Quality (US) | edition = Evidence Reports/Technology Assessments, No. 219 | doi-access = free }}</ref> Leta 2016 je ameriška Agencija za raziskave in kakovost v zdravstvu objavila, da obstaja veliko različnih načinov obvladovanja SKU, da pri številnih bolnikih uporabljajo večplastne pristope, vendar pa da nobeno zdravilo uradno ni odobreno za zdravljenje te bolezni. Se pa nekatera zdravila uporabljajo [[nenamenska uporaba|nenamensko]]. V poročilu so zaključili, da sta svetovanje in terapija s stopnjevano aktivnostjo pokazala določene učinke, vendar ni dovolj raziskav, da bi ju lahko priporočili za vse bolnike. Podatki tudi kažejo, da lahko terapija s stopnjevano aktivnostjo poslabša simptome pri nekaterih bolnikih.<ref name="AHRQ discussion">{{cite journal | vauthors author1= Smith ME, |author2=Nelson HD, |author3=Haney E, |author4=Pappas M, |author5=Daeges M, |author6=Wasson N, |author7=McDonagh M | title = Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome | journal = Evidence Report/Technology Assessment | issue = 219 | pages = 1–433 | date = december 2014 | pmid = 30313001 | doi = 10.23970/AHRQEPCERTA219 | url = https://www.ncbi.nlm.nih.gov/books/NBK293934 | access-date = 22. 1. 2016 | publisher = Agency for Healthcare Research and Quality (US) | edition = Evidence Reports/Technology Assessments, No. 219 | doi-access = free }}</ref> Zaradi možnosti škodljivih učinkov CDC terapije s stopnjevalno aktivnostjo več ne priporoča.<ref name="Vink2018" >{{cite journal | vauthors author1= Vink M, |author2=Vink-Niese A | title = Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review | journal = Health Psychology Open | volume = 5 | issue = 2 | pages = 2055102918805187 | date = 2018-07-01 | pmid = 30305916 | pmc = 6176540 | doi = 10.1177/2055102918805187 | quote = The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings, there is no evidence that graded exercise therapy is effective. Because of the failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe. The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment for myalgic encephalomyelitis/chronic fatigue syndrome... The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings, there is no evidence that graded exercise therapy is effective. Because of the failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe. The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment for myalgic encephalomyelitis/chronic fatigue syndrome. }}</ref><ref name="Smith2016">{{cite journal |vauthorsauthor1=Smith ME, |author2=Nelson HD, |author3=Haney E, |author4=Pappas M, |author5=Daeges M, |author6=Wasson N, |author7=McDonagh M |date=julij 2016|title=julij 2016 Addendum. In Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome 2014 Dec.|url=https://www.ncbi.nlm.nih.gov/books/NBK379582/|journal=Evidence Report/Technology Assessment|publisher=Agency for Healthcare Research and Quality (US)|pages=1–433|quote=The results are consistent across trials with improvement in function, fatigue, and global improvement and provided moderate strength of evidence for improved function (4 trials, n=607) and global improvement (3 trials, n=539), low strength of evidence for reduced fatigue (4 trials, n=607) and decreased work impairment (1 trial, n=480), and insufficient evidence for improved quality of life (no trials)}}</ref> Smernice CDC glede zdravljenja SKU pravijo, da zdravilo, ki bi pozdravilo bolezen, ne obstaja, obstaja pa več načinov blaženja simptomov,<ref name="CDC2020treat" /> na primer za lajšanje težav s spanjem, bolečine, omotice in vrtoglavice ter težav s spominom in koncentracijo.<ref name=CDC2020treat/>

[[Kategorija:NevrološkeBolezni bolezniin motnje živčevja]]