Strober M, Freeman R, Lampert C, Diamond J, Kaye W
Department of Psychiatry and Biobehavioral Sciences and the Neuropsychiatric Institute and Hospital, University of California, Los Angeles 90024-1759, USA.
Am J Psychiatry. 2000 Mar;157(3):393-401. doi: 10.1176/appi.ajp.157.3.393.
Lifetime rates of full and partial anorexia nervosa and bulimia nervosa were determined in first-degree relatives of diagnostically pure proband groups and relatives of matched, never-ill comparison subjects.
Rates of each eating disorder were obtained for 1,831 relatives of 504 probands on the basis of personal structured clinical interviews and family history. Best-estimate diagnoses based on all available information were rendered without knowledge of proband status and pedigree identity. Only definite and probable diagnoses were considered.
Whereas anorexia nervosa was rare in families of the comparison subjects, full and partial syndromes of anorexia nervosa aggregated in female relatives of both anorexic and bulimic probands. For the full syndrome of anorexia nervosa, the relative risks were 11.3 and 12.3 in female relatives of anorexic and bulimic probands, respectively. Bulimia nervosa was more common than anorexia nervosa in female relatives of comparison subjects, but it, too, aggregated in the families of ill probands; the corresponding relative risks for bulimia nervosa were 4.2 and 4.4 for female relatives of anorexic and bulimic probands, respectively. When partial syndromes of anorexia nervosa and bulimia nervosa were considered, relative risks fell by one-half in each group of ill probands.
Both anorexia nervosa and bulimia nervosa are familial. Their cross-transmission in families suggests a common, or shared, familial diathesis. The additional observation that familial aggregation and cross-transmission extend to milder phenotypes suggests the validity of their inclusion in a continuum of familial liability.
确定诊断明确的先证者组的一级亲属以及匹配的、从未患病的对照受试者亲属中神经性厌食症和神经性贪食症的终生患病率及部分患病率。
基于个人结构化临床访谈和家族病史，对504名先证者的1831名亲属进行了每种饮食失调症的患病率调查。在不知道先证者状态和系谱身份的情况下，根据所有可用信息做出最佳估计诊断。仅考虑明确和可能的诊断。
对照受试者家庭中神经性厌食症罕见，而神经性厌食症的完全型和部分型综合征在神经性厌食症和神经性贪食症先证者的女性亲属中聚集。对于神经性厌食症的完全型综合征，神经性厌食症和神经性贪食症先证者的女性亲属的相对风险分别为11.3和12.3。神经性贪食症在对照受试者的女性亲属中比神经性厌食症更常见，但它也在患病先证者的家庭中聚集；神经性贪食症在神经性厌食症和神经性贪食症先证者的女性亲属中的相应相对风险分别为4.2和4.4。当考虑神经性厌食症和神经性贪食症的部分型综合征时，每组患病先证者的相对风险降低一半。
神经性厌食症和神经性贪食症都具有家族性。它们在家族中的交叉传递表明存在共同的家族素质。另外的观察结果是，家族聚集和交叉传递延伸到较轻的表型，这表明将它们纳入家族易感性连续体是有效的。
