慢性肾脏病相关疲乏的评估：患者报告结局量表的选择

doi:10.12114/j.issn.1007-9572.2024.0080

中国全科医学 ›› 2026, Vol. 29 ›› Issue (13): 1784-1792.DOI: 10.12114/j.issn.1007-9572.2024.0080

• 论著·方法学研究 • 上一篇

慢性肾脏病相关疲乏的评估：患者报告结局量表的选择

段若兰¹, 丘伽美¹, 杨长沅¹^,², 李琴¹, 莫浩钰¹, 皮敏晖¹, 杨振华¹, 夏蔼³, 张腊¹, 刘旭生¹, 卢富华¹, 侯海晶¹^,^*(), 苏国彬¹^,⁴^,⁵^,^*()

1．510120　广东省广州市，中医证候全国重点实验室　广州中医药大学第二临床医学院　中医药广东省实验室　广东省中医药防治难治性慢病重点实验室　广东省中医院肾病科　中医药大数据研究团队　刘旭生广东省名中医传承工作室
2．9713GZ　荷兰格罗宁根市，格罗宁根大学医学中心肾内科
3．100700　北京市，北京中医药大学东直门医院肾病内分泌科四区
4．11228　瑞典斯德哥尔摩市，卡罗林斯卡医学院流行病学和生物统计学系
5．OX12JD　英国牛津，牛津大学纳菲尔德人群健康系

收稿日期:2025-05-10 修回日期:2025-12-15 出版日期:2026-05-05 发布日期:2026-04-14
通讯作者: 侯海晶, 苏国彬
作者贡献：
段若兰提出文章的构思与设计，研究资料的收集与整理、论文起草、撰写；丘伽美、杨长沅负责资料收集、论文撰写；李琴、莫浩钰、皮敏晖、杨振华负责表格绘制、编辑、整理；夏蔼、张腊、刘旭生、卢富华负责论文修改、文章的质量控制及审校；侯海晶、苏国彬负责最终版本修订，对论文负责
基金资助:
国家自然科学基金资助项目(82004205); 教育部"春晖计划"合作科研项目(HZKY20220109); 广东省中医院拔尖人才科研专项资助(BJ2022KY11); 广东省中医院科学技术研究基金(YN2018QL08); 国家中医药管理局中医药防治新型冠状病毒感染应急研究专项课题(2023ZYLCYJ02-18); 深圳市"医疗卫生三名工程"项目资助(SZZYSM202206014); 广东省中医院中医药科学技术研究专项资助(YN2020QN18); 广东省中医院中医药科学技术研究专项资助(YN2020QN24)

Assessment of Fatigue in Patients with Chronic Kidney Disease: the Choice of Patient-reported Outcome Measures Scales

DUAN Ruolan¹, QIU Jiamei¹, YANG Changyuan¹^,², LI Qin¹, MO Haoyu¹, PI Minhui¹, YANG Zhenhua¹, XIA Ai³, ZHANG La¹, LIU Xusheng¹, LU Fuhua¹, HOU Haijing¹^,^*(), SU Guobin¹^,⁴^,⁵^,^*()

1. Department of Nephrology, the Second Clinical Medical College/the Second Affiliated Hospital of Guangzhou University of Chinese Medicine/State Key Laboratory of Traditional Chinese Medicine Syndrome/Guangdong Provincial Key Laboratory of Chinese Medicine/Guangdong Provincial Key Laboratory of Chinese Medicine for Prevention and Treatment of Refractory Chronic Diseases/Guangdong Provincial Hospital of Chinese Medicine/Traditional Chinese Medicine Big Data Research Team/Liu Xusheng's Guangdong Famous TCM Doctor Inheritance Studio, Guangzhou 510120, China
2. Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen 9713GZ, The Netherlands
3. Department of Nephrology and Endocrinology, Dongzhimen Hospital, Beijing University of Chinese Medicine 100700, Beijing, China
4. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm 11228, Sweden
5. Nuffield Department of Population Health, University of Oxford, Oxford OX12JD, UK

Received:2025-05-10 Revised:2025-12-15 Published:2026-05-05 Online:2026-04-14
Contact: HOU Haijing, SU Guobin

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摘要/Abstract

摘要： 背景疲乏是慢性肾脏病（CKD）患者最常见的症状，并且与较低的生活质量和较高的死亡风险密切相关。目前常用患者报告结局评估量表（PROM）评估CKD相关疲乏，然而此类量表形式各异，适用人群有所侧重，尚未形成一致的共识，影响临床选择应用。目的系统评价各量表的优缺点及适用人群，为临床工作者选择合适的评估量表提供参考。方法系统检索PubMed、Web of Science、中国知网、维普网、万方数据知识服务平台，筛选与CKD疲乏评估相关文献，检索时间限制为2018年1月—2024年4月，数据由两位研究者独立筛选和提取，通过对比各量表的评估方式、优缺点等，探索分析不同CKD人群疲乏评估量表的选择。结果 CKD相关疲乏量表主要分为普适性量表和特殊人群量表，量表均采用Likert法评估。健康状况调查量表、透析症状指数量表（DSI）适用于CKD疲乏症状的筛查；Piper疲乏修订量表（PFS-R）作为多维度量表，临床应用最广泛，能够明确区分疲乏程度和维度，可能较适合CKD患者的疲乏评估。结论 CKD相关疲乏评估量表众多，临床从业者需综合考虑CKD研究人群特点，选择疲乏评估量表。

关键词: 肾脏病学, 慢性肾脏病, 疲乏, 患者报告结局评估量表, 普适性疲乏量表, 特殊人群疲乏量表

Abstract:

Background

Fatigue is prevalent in patients with chronic kidney disease (CKD) and closely associated with reduced quality of life and increased mortality. Currently, Patient-reported Outcome Measures (PROMs) are commonly employed to assess fatigue. However, these measures exhibit variations in format. There is no consensus about how to choose an appropriate one to use in clinical practice.

Objective

Systematically assess the advantages, disadvantages, and target populations of various scales to provide clinical practitioners with a reference for choosing appropriate assessment tools.

Methods

A systematic search of database like PubMed, Web of Science, CNKI, VIP, and Wanfang Data was conducted for literatures about fatigue assessment in patients with CKD, from January 2018 to April 2024. The data were independently screened and extracted by two researchers, and by comparing the assessment methods, advantages and disadvantages of each scale to inform the choice of fatigue assessment scales in different CKD populations.

Results

The study reveals that CKD-related fatigue scales can be categorized into general fatigue scales and specific population fatigue scale. All these scales employ Likert scale for fatigue assessment. We found that health status survey instruments and the Dialysis Symptom Index Scale (DSI) were suitable for screening fatigue symptoms in CKD; the Piper Fatigue Scale-Revised (PFS-R) with multidimensional scale was the most commonly used in clinical practice and a promising scale for the assessment of fatigue in CKD because it could clearly differentiate between the degree and dimensions of fatigue.

Conclusion

There are many fatigue scales to assess fatigue for patients with CKD. Clinical practitioners should consider the characteristics of the CKD study population comprehensively and choose the appropriate scale for fatigue assessment.

Key words: Nephrology, Chronic kidney disease, Fatigue, Patient-reported outcome measures, General fatigue scale, Specific population fatigue scale

中图分类号:

R 692

段若兰,丘伽美,杨长沅,等. 慢性肾脏病相关疲乏的评估：患者报告结局量表的选择[J]. 中国全科医学, 2026, 29(13): 1784-1792. DOI: 10.12114/j.issn.1007-9572.2024.0080.
DUAN Ruolan,QIU Jiamei,YANG Changyuan, et al. Assessment of Fatigue in Patients with Chronic Kidney Disease: the Choice of Patient-reported Outcome Measures Scales[J]. Chinese General Practice, 2026, 29(13): 1784-1792. DOI: 10.12114/j.issn.1007-9572.2024.0080.

图/表 2

参考文献 79

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PROM	构成	评分与分级	疲乏评估期限	评估用时	优点	缺点	信度分析	效度分析	研究人群
普适性疲乏量表（单维度PROM）
SF-36	共36项条目；活力部分：4项条目；生活充实、精力、体力、厌烦等主观感受	6级Likert评分法；总分^a0~100分；分数越高，疲乏程度越轻	过去4周	10~15 min	生活质量评价的通用工具；算法独特	灵敏度低；缺乏疲乏判定阈值；活力不足无法完全反映疲乏	Cronbach's α系数=0.86^[58]	校标关联效度：0.85	非透析CKD^[59]、HD^[60]、PD^[61]
SF-12^a	共12项条目；精力充足程度	6级Likert评分法；总分^a0~100分；分数越高，疲乏程度越轻	过去4周	5~10 min	生活质量评价的通用工具；内容精简	灵敏度低；仅一个疲乏相关条目，对疲乏测量不足；	Cronbach's α系数=0.775^[62]	探索性因子分析：2个因子，累积贡献率为59.0%	非透析CKD^[63]、HD^[64]
VAS-F^a	1项条目：疲乏的严重程度	11级Likert评分法总分0~10分；无疲倦~极度疲倦	当前	<1 min	直观；内容简洁；耗时短	易冲动性回答；易回避极端评价	Cronbach's α系数=0.89^[65]	内容效度：0.89	HD^[66]、PD^[67]
FSS^a	9项条目：疲乏严重程度、对生活影响	7级Likert评分法；各条目得分：1分~7分；非常不同意~非常同意；总分9~63分；>36分，考虑疲乏	过去1周	<5 min	内容简洁；耗时较短；时间稳定性好；灵敏度高；有疲乏阈值	缺乏疲乏的内容维度评估	Cronbach's α系数=0.893；重测信度=0.905^[28]	探索性因子分析：1个因子，累积方差贡献率为57.81%	非透析CKD^[68]、HD^[31,32]、PD^[69]
普适性疲乏量表（多维度PROM）
FS-14^a	14项条目：躯体疲乏、脑力疲乏	"是"=1分、"否"=0分；总分0~14分；分数越高，疲乏程度越重	当前	<5 min	耗时较短；便于理解	缺乏疲乏判定阈值；脑力疲乏易与抑郁相混淆	Cronbach's α系数=0.88^[34]	—	HD
PFS-R^a	22项条目：行为、情感、感知、认知/情绪4个维度	11级Likert评分法；总分0~10分；0分为无疲乏；1~3分为轻度疲乏；4~6分为中度疲乏；7~10分为重度疲乏	当前	5~10 min	直观反映疲乏对各维度影响；疲乏分级明确；	耗时略长	Cronbach's α系数=0.91；重测信度=0.98^[70]	—	HD^[38]、PD^[71]
FACIT-F	13项条目：身体、功能、情感和社交等方面	5级Likert评分法；各条目得分：0~4分，依次为一点也不~非常；总分0~52分；分数越高，疲乏程度越轻	过去1周	<5 min	耗时较短；与临床指标存在较好的相关性；中文版量表信度高；方便监测疲乏	疲乏判定阈值不一致	Cronbach's α系数=0.929；重测信度=0.965^[43]	校标关联效度：Pearson相关系数为-0.464	非透析CKD^[11]、HD^[72]、PD^[73]
MFI-20	20项条目：一般疲乏、身体疲乏、精神疲乏、活动减少、动力减少5个维度	5级Likert评分法；各条目得分：1~5分；完全不符合~完全符合；总分20~100分；分数越高，疲乏程度越重	最近	5~10 min	灵敏度高；CKD人群信度低	耗时略长；理解难度稍高；	Cronbach's α系数=0.35 ^[50]	—	非透析CKD^[45]、HD^[48]、PD^[74]
特殊人群疲乏量表
DSI	3项条目：疲乏的频率、严重性以及其对生活质量的影响	5级Likert评分法；总分0~120分；分数越高，疲乏程度越重	过去1周	<3 min	内容简洁；耗时短；	缺乏对疲乏的特异度评估	Cronbach's α系数=0.87；重测信度：0.92^[75]	内容效度：0.90	CKD 4~5期^[16]、HD^[51]
SONG-HD	3项条目：疲乏、缺乏活力、日常活动	4级Likert评分法；总分0~9分，依次为完全没有疲乏~严重疲乏	过去1周	<3 min	核心结果测量；内容简洁；耗时短	英语形式；国内应用少	Cronbach's α系数=0.861；重测信度=0.695^[76]	收敛效度：Spearman秩相关系数为0.691	HD^[53,54]
KDQOL-SF	43项条目；SF-36活力部分及肾病对生活的影响	6级Likert评分法；总分^b：0~100分；分数越高，疲乏程度越轻	过去4周	约30 min	特异度高，反映CKD患者	耗时时间长；活力不足无法完全反映疲乏	Cronbach's α系数=0.902；重测信度=0.990^[77]	探索性因子分析：4个因子，累积解释方差贡献率为65.13%	非透析CKD^[78]、PD^[61]、HD^[79]

PROM	构成	评分与分级	疲乏评估期限	评估用时	优点	缺点	信度分析	效度分析	研究人群
普适性疲乏量表（单维度PROM）
SF-36	共36项条目；活力部分：4项条目；生活充实、精力、体力、厌烦等主观感受	6级Likert评分法；总分^a0~100分；分数越高，疲乏程度越轻	过去4周	10~15 min	生活质量评价的通用工具；算法独特	灵敏度低；缺乏疲乏判定阈值；活力不足无法完全反映疲乏	Cronbach's α系数=0.86^[58]	校标关联效度：0.85	非透析CKD^[59]、HD^[60]、PD^[61]
SF-12^a	共12项条目；精力充足程度	6级Likert评分法；总分^a0~100分；分数越高，疲乏程度越轻	过去4周	5~10 min	生活质量评价的通用工具；内容精简	灵敏度低；仅一个疲乏相关条目，对疲乏测量不足；	Cronbach's α系数=0.775^[62]	探索性因子分析：2个因子，累积贡献率为59.0%	非透析CKD^[63]、HD^[64]
VAS-F^a	1项条目：疲乏的严重程度	11级Likert评分法总分0~10分；无疲倦~极度疲倦	当前	<1 min	直观；内容简洁；耗时短	易冲动性回答；易回避极端评价	Cronbach's α系数=0.89^[65]	内容效度：0.89	HD^[66]、PD^[67]
FSS^a	9项条目：疲乏严重程度、对生活影响	7级Likert评分法；各条目得分：1分~7分；非常不同意~非常同意；总分9~63分；>36分，考虑疲乏	过去1周	<5 min	内容简洁；耗时较短；时间稳定性好；灵敏度高；有疲乏阈值	缺乏疲乏的内容维度评估	Cronbach's α系数=0.893；重测信度=0.905^[28]	探索性因子分析：1个因子，累积方差贡献率为57.81%	非透析CKD^[68]、HD^[31,32]、PD^[69]
普适性疲乏量表（多维度PROM）
FS-14^a	14项条目：躯体疲乏、脑力疲乏	"是"=1分、"否"=0分；总分0~14分；分数越高，疲乏程度越重	当前	<5 min	耗时较短；便于理解	缺乏疲乏判定阈值；脑力疲乏易与抑郁相混淆	Cronbach's α系数=0.88^[34]	—	HD
PFS-R^a	22项条目：行为、情感、感知、认知/情绪4个维度	11级Likert评分法；总分0~10分；0分为无疲乏；1~3分为轻度疲乏；4~6分为中度疲乏；7~10分为重度疲乏	当前	5~10 min	直观反映疲乏对各维度影响；疲乏分级明确；	耗时略长	Cronbach's α系数=0.91；重测信度=0.98^[70]	—	HD^[38]、PD^[71]
FACIT-F	13项条目：身体、功能、情感和社交等方面	5级Likert评分法；各条目得分：0~4分，依次为一点也不~非常；总分0~52分；分数越高，疲乏程度越轻	过去1周	<5 min	耗时较短；与临床指标存在较好的相关性；中文版量表信度高；方便监测疲乏	疲乏判定阈值不一致	Cronbach's α系数=0.929；重测信度=0.965^[43]	校标关联效度：Pearson相关系数为-0.464	非透析CKD^[11]、HD^[72]、PD^[73]
MFI-20	20项条目：一般疲乏、身体疲乏、精神疲乏、活动减少、动力减少5个维度	5级Likert评分法；各条目得分：1~5分；完全不符合~完全符合；总分20~100分；分数越高，疲乏程度越重	最近	5~10 min	灵敏度高；CKD人群信度低	耗时略长；理解难度稍高；	Cronbach's α系数=0.35 ^[50]	—	非透析CKD^[45]、HD^[48]、PD^[74]
特殊人群疲乏量表
DSI	3项条目：疲乏的频率、严重性以及其对生活质量的影响	5级Likert评分法；总分0~120分；分数越高，疲乏程度越重	过去1周	<3 min	内容简洁；耗时短；	缺乏对疲乏的特异度评估	Cronbach's α系数=0.87；重测信度：0.92^[75]	内容效度：0.90	CKD 4~5期^[16]、HD^[51]
SONG-HD	3项条目：疲乏、缺乏活力、日常活动	4级Likert评分法；总分0~9分，依次为完全没有疲乏~严重疲乏	过去1周	<3 min	核心结果测量；内容简洁；耗时短	英语形式；国内应用少	Cronbach's α系数=0.861；重测信度=0.695^[76]	收敛效度：Spearman秩相关系数为0.691	HD^[53,54]
KDQOL-SF	43项条目；SF-36活力部分及肾病对生活的影响	6级Likert评分法；总分^b：0~100分；分数越高，疲乏程度越轻	过去4周	约30 min	特异度高，反映CKD患者	耗时时间长；活力不足无法完全反映疲乏	Cronbach's α系数=0.902；重测信度=0.990^[77]	探索性因子分析：4个因子，累积解释方差贡献率为65.13%	非透析CKD^[78]、PD^[61]、HD^[79]

慢性肾脏病相关疲乏的评估：患者报告结局量表的选择

Assessment of Fatigue in Patients with Chronic Kidney Disease: the Choice of Patient-reported Outcome Measures Scales

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