慢性疲劳综合征肌肉病理生理的Scoping综述

doi:10.3969/j.issn.1006-9771.2026.08.003

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (8): 892-902.doi: 10.3969/j.issn.1006-9771.2026.08.003

慢性疲劳综合征肌肉病理生理的Scoping综述

王子龙¹, 李宏玉¹^,², 王志浩¹, 李洪欣¹, 江莹莹¹, 唐强¹^,²()

¹ 黑龙江中医药大学，黑龙江哈尔滨市 150040
² 黑龙江中医药大学附属第二医院，黑龙江哈尔滨市 150001

收稿日期:2025-07-26 修回日期:2025-10-11 接受日期:2025-10-31 出版日期:2026-08-25 发布日期:2026-08-25
通讯作者: 唐强，E-mail： tangqiang1963@163.com
作者简介:王子龙(2001-)，男，汉族，山东淄博市人，硕士研究生，主要研究方向：功能障碍的康复治疗临床与基础研究。
唐强(1963-)，男，汉族，四川大竹县人，博士，教授，主要研究方向：慢性病常见功能障碍的中医康复。

Pathophysiology in muscle fatigue in myalgic encephalomyelitis/chronic fatigue syndrome: a scoping review

Wang Zilong¹, Li Hongyu¹^,², Wang Zhihao¹, Li Hongxin¹, Jiang Yinying¹, Tang Qiang¹^,²()

¹ Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150040, China
² The Second Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, Heilongjiang 150001, China

Received:2025-07-26 Revised:2025-10-11 Accepted:2025-10-31 Published:2026-08-25 Online:2026-08-25
Contact: Tang Qiang，E-mail： tangqiang1963@163.com

摘要/Abstract

摘要：

目的系统梳理慢性疲劳综合征(ME/CFS)肌肉疲劳的相关病理生理机制。

方法检索PubMed、Web of Science核心合集、Embase、Cochrane Library、EBSCO (CINAHL)、中国知网、万方数据库、维普数据库建库至2025年7月关于ME/CFS相关基础和临床研究，整合线粒体能量代谢障碍、神经肌肉接头功能异常、自主神经调控失衡和免疫炎症反应等多维证据，评估肌肉在中枢-免疫-代谢-神经调控网络中的作用及其与临床表型的关联。

结果 ME/CFS患者普遍存在线粒体供能受限、氧化应激、离子稳态紊乱、神经肌肉接头传递稳定性下降、中枢驱动不足和直立不耐受等问题，导致易跨越无氧阈并诱发劳力后不适。

结论肌肉病理生理在ME/CFS发病和症状持续中居于重要地位。康复实践应以安全边界优先，避免诱发劳力后不适。

关键词: 慢性疲劳综合征, 肌肉疲劳, 病理生理, Scoping综述

Abstract:

Objective To systematically summarize the relevant pathophysiology underlying muscle fatigue in myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS).

Methods Databases including PubMed, Web of Science Core Collection, Embase, Cochrane Library, EBSCO (CINAHL), CNKI, Wanfang Data and VIP Database were searched from their inception to July, 2025 for basic and clinical studies related to ME/CFS. Multidimensional evidence involving mitochondrial, neuromuscular junction dysfunction, autonomic dysregulation and immune-inflammatory responses was integrated. The role of muscles in the central-immune-metabolic-neural regulatory network and its association with clinical phenotypes were evaluated.

Results Patients with ME/CFS commonly presented with impaired mitochondrial energy supply, oxidative stress, ion homeostasis disorders, reduced stability of neuromuscular junction transmission, insufficient central drive and postural intolerance. These abnormalities resulted in a predisposition to cross the anaerobic threshold and trigger post-exertional malaise.

Conclusion Muscle pathophysiology plays a critical role in the pathogenesis and symptom persistence of ME/CFS. Rehabilitation practice should prioritize safety boundaries to avoid post-exertional malaise.

Key words: chronic fatigue syndrome, muscle fatigue, pathophysiology, scoping review

中图分类号:

R746.9

王子龙, 李宏玉, 王志浩, 李洪欣, 江莹莹, 唐强. 慢性疲劳综合征肌肉病理生理的Scoping综述[J]. 《中国康复理论与实践》, 2026, 32(8): 892-902.

Wang Zilong, Li Hongyu, Wang Zhihao, Li Hongxin, Jiang Yinying, Tang Qiang. Pathophysiology in muscle fatigue in myalgic encephalomyelitis/chronic fatigue syndrome: a scoping review[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(8): 892-902.

图/表 4

图 1

表1

纳入文献基本特征"

纳入文献	国家	研究类型	患者/模型类型	证据类型	结局	二级主题
Naviaux等^[4] (2016)	美国	病例-对照研究	CFS患者+健康对照	生化分析/代谢组学	代谢异常导致疲劳增加	能量代谢失衡
Wang等^[5] (2023)	美国	实验研究/病例-对照研究	ME/CFS患者+健康对照；细胞及转基因小鼠模型	分子生物学/线粒体研究	线粒体呼吸中断导致运动耐受下降	能量代谢失衡
Lawson等^[6](2016)	美国	病例-对照研究	CFS患者+配对健康对照	细胞生物学/线粒体功能分析	细胞能量代谢及线粒体结构发生异常	能量代谢失衡
McCully等^[7] (2003)	英国	病例-对照研究	CFS患者+健康对照	生理学/影像学	肌肉代谢异常导致肌肉痛增加	能量代谢失衡
Vermeulen等^[8] (2010)	荷兰	病例-对照研究/重复运动试验	CFS患者+健康对照	生理学/运动测试	氧化磷酸化异常导致PEM恶化	能量代谢失衡
Tomas等^[9](2019)	英国	病例-对照研究	CFS患者和健康对照来源细胞	线粒体功能/呼吸链复合体分析	细胞线粒体呼吸链复合体功能异常	能量代谢失衡
Jammes等^[10] (2005)	法国	病例-对照研究	CFS患者+健康对照	生理学/氧化应激分析	氧化应激增加导致肌肉兴奋性	能量代谢失衡
Jones等^[11] (2010)	英国	观察性病例-对照研究	CFS/ME患者+健康对照	生理学/pH分析	肌肉pH异常导致自主神经失衡	能量代谢失衡
Brown等^[12] (2018)	英国	体外实验研究	ME/CFS患者来源骨骼肌细胞+健康对照来源细胞	分子生物学/药理学	葡萄糖摄取异常导致肌肉功能减弱	能量代谢失衡
Tomas等^[13] (2020)	英国	病例-对照研究/二次数据分析	ME/CFS患者+健康对照	分子生物学/生物能量分析	生物能量功能下降导致严重疲劳	能量代谢失衡
Sachdeva等^[14] (2009)	印度	动物实验	CFS小鼠模型	行为学/生化分析	生化异常导致行为疲劳增加	能量代谢失衡
Hornig等^[15] (2016)	美国	病例-对照研究	ME/CFS患者+对照	免疫学/脑脊液分析	细胞因子网络异常导致认知疲劳增加	免疫炎症级联反应
Montoya等^[16](2017)	美国	病例-对照观察性研究	ME/CFS患者+健康对照	血清细胞因子/多重免疫分析	细胞免疫功能异常导致肌肉痛加重	免疫炎症级联反应
Kodama等^[17] (2025)	日本	回顾性观察性研究/病例系列	COVID-19疫苗接种后ME/CFS患者	临床/营养干预	免疫异常导致疲劳症状改善	免疫炎症级联反应
Cliff等^[18] (2019)	英国	病例-对照观察性研究	ME/CFS患者+MS患者+健康对照	免疫学/细胞功能分析	细胞免疫功能异常导致疲劳增加	免疫炎症级联反应
Russell等^[19] (2016)	美国	纵向/观察性队列研究	CFS/ME患者+对照	免疫学/进展分析	免疫基线变化导致疾病进展加重	免疫炎症级联反应
Hickie等^[20] (2006)	澳大利亚	前瞻性队列研究	感染后患者，随访形成CFS患者	临床/病原体分析	病原体诱发慢性疲劳增加	免疫炎症级联反应
Maes等^[21] (2013)	比利时	横断面病例-对照研究	ME/CFS患者	免疫学/自身免疫分析	自身免疫活动增加导致炎症途径激活	免疫炎症级联反应
Park等^[22] (2019)	韩国	病例-对照比较研究	CFS患者+癌症相关疲劳患者	心理生理学/多维比较	心理生理标记异常导致疲劳/疼痛增加	免疫炎症级联反应
Fluge等^[23] (2019)	挪威	随机、双盲、安慰剂对照试验	ME/CFS患者	临床试验/免疫学	B细胞耗竭导致症状改善	免疫炎症级联反应
Ghali等^[24] (2021)	法国	回顾性观察性研究	ME/CFS患者	临床观察/统计分析	PEM警告信号导致临床表型恶化	神经肌肉调控异常
Zeineh等^[25] (2015)	美国	病例-对照影像学研究	CFS患者+健康对照	影像学/脑结构分析	脑弓状束异常导致认知疲劳增加	神经肌肉调控异常
Wu等^[26] (2016)	中国	病例-对照横断面研究	CFS患者+健康对照	神经生理学/脑电分析	脑电特征异常导致认知障碍加重	神经肌肉调控异常
Thakur等^[27] (2020)	印度	动物实验	实验性CFS小鼠模型	行为学/神经递质分析	神经递质失衡导致疲劳行为增加	神经肌肉调控异常
Natelson等^[28] (2017)	美国	病例-对照横断面研究	CFS患者+健康对照	多模态评估/影像学/生化	脑脊液异常导致精神共病疲劳加重	神经肌肉调控异常
He等^[29] (2020)	日本	动物实验	CFS小鼠模型	行为学/分子生物学	神经炎症、氧化应激及神经发生异常	神经肌肉调控异常
Xu等^[30] (2022)	中国	动物实验	中枢疲劳大鼠模型	分子生物学/途径分析	γ-氨基丁酸/谷氨酸失衡导致认知/情绪障碍	神经肌肉调控异常

表1

表2

表3

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分类维度	分类名称	定义与特征
发生部位	中枢性疲劳	涉及中枢神经系统(如大脑或脊髓)的功能失调，导致运动指令传递效率下降或运动意愿减弱^[37]
发生部位	外周性疲劳	主要发生在肌肉本身或神经肌肉接头处，表现为肌肉收缩能力下降或能量供应不足^[37]
疲劳程度	轻度	表现为短暂的肌肉无力或酸痛，稍事休息即可恢复，属于正常生理现象^[38]
	中度	肌肉功能明显下降，需要较长时间的休息和恢复^[38]
	重度	肌肉功能严重受损，可能伴随疼痛或运动障碍，需要专业的干预和恢复措施^[38]
机制	能量耗竭型	由于肌肉内能量物质(如ATP、糖原)的耗竭，导致肌肉无法持续收缩^[39]
	代谢产物积累型	由于乳酸等代谢产物的积累，导致肌肉pH值下降，影响肌肉收缩功能^[39]
	神经调节失调型	由于中枢神经系统或外周神经的功能失调，导致肌肉收缩指令传递受阻^[39]

神经递质	变化方向	主要影响脑区	电生理表现	与疲劳关联度
5-羟色胺^[72-78]	功能紊乱(非单纯升高)	基底节、边缘系统、脑干	皮质抑制功能改变，睡眠结构紊乱(如慢波睡眠减少)	间接相关
多巴胺^[79-81]	功能减退	纹状体、前额叶皮质	MEP振幅下降，运动阈值升高	强负相关
谷氨酸^[14,27,30]	波动性升高	运动皮质、前扣带回	神经元超兴奋性(可能导致能量衰竭)，谷氨酸升高	间接相关
γ-氨基丁酸^[82-85]	失衡(证据不一，可能存在代偿性变化)	丘脑、感觉皮质	皮质抑制功能改变(如皮质静默期延长)	间接相关

慢性疲劳综合征肌肉病理生理的Scoping综述

Pathophysiology in muscle fatigue in myalgic encephalomyelitis/chronic fatigue syndrome: a scoping review

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