Cros G, Sznajder M, Meuric S, Mignot C, Chevallier B, Stheneur C
Service de pédiatrie générale, hôpital Ambroise-Paré, 9, avenue Charles-de-Gaulle, 92100 Boulogne, France.
Arch Pediatr. 2010 Feb;17(2):112-7. doi: 10.1016/j.arcped.2009.10.026. Epub 2009 Nov 28.
Rapid undernutrition in patients with anorexia nervosa can compromise vital functions, notably due to cardiac complications. The aim of this study was to analyze the clinical parameters of anorexic patients, hospitalized for substantial weight loss, in a general pediatric inpatient unit, in order to determine which parameters should be tested by the medical doctor.
We performed a retrospective study on 20 consecutive patients (18 girls), median age of 13.75 (+/-2.3) years, admitted for the first time in our pediatric inpatient unit for anorexia nervosa.
Symptoms evolved for a median duration of 11.5 (+/-10.2) months before admittance and was shorter for the youngest patients (r = 0.42, p = 0.067). The mean BMI was 13.3 (+/-0.6) kg/m(2) (-3.0+/-1.2 Z-score) and was inversely correlated with serum creatinine levels (74+/-15 micromol/l) (r = 0.44, p < 0.05). The mean BMI variation between the beginning of the disease and hospitalization (Delta BMI) was-3.5 Z-score and was correlated to low systolic blood pressure (r = 0.45, p< or =0.05) and the presence of a pericardial effusion at admittance (r = 0.45, p < 0.05). Complete blood count, electrolyte balance and the serum phosphorus levels were normal except in 1 case. Mean serum glucose was 3.5+/-1.2 mmol/l. At admittance, an electrocardiogram, performed for 16 patients, showed sinusal bradycardia without conduction impairment. Enteral nutrition was necessary for 14 patients (70%) for a mean duration of 18.1 days (range, 6-56 days). The mean weight gain was 3.1+/-2 kg and was inversely correlated to the BMI at admittance (r = 0.49, p < 0.05).
Medical supervision of undernutrition tolerance during anorexia nervosa is above all clinical, as hematological and biological parameters remain normal for a long time. The cardiac complications found in our study appeared to be more related to the rapid rate of weight loss than to the amount of weight loss itself.
神经性厌食症患者的快速营养不良会损害重要功能，尤其是由于心脏并发症。本研究的目的是分析在普通儿科住院病房因体重显著减轻而住院的厌食症患者的临床参数，以确定医生应检测哪些参数。
我们对20例连续入院的患者（18名女孩）进行了一项回顾性研究，这些患者首次入住我们的儿科住院病房，诊断为神经性厌食症，中位年龄为13.75（±2.3）岁。
症状在入院前的中位持续时间为11.5（±10.2）个月，最年轻患者的症状持续时间较短（r = 0.42，p = 0.067）。平均体重指数（BMI）为13.3（±0.6）kg/m²（-3.0±1.2 Z评分），与血清肌酐水平（74±15 μmol/l）呈负相关（r = 0.44，p < 0.05）。疾病开始至住院期间的平均BMI变化（ΔBMI）为-3.5 Z评分，与收缩压降低相关（r = 0.45，p≤0.05），且与入院时心包积液的存在相关（r = 0.45，p < 0.05）。除1例患者外，全血细胞计数、电解质平衡和血清磷水平均正常。平均血清葡萄糖为3.5±1.2 mmol/l。入院时，对16例患者进行的心电图检查显示窦性心动过缓，无传导障碍。14例患者（70%）需要进行肠内营养，平均持续时间为18.1天（范围为6 - 56天）。平均体重增加3.1±2 kg，与入院时的BMI呈负相关（r = 0.49，p < 0.05）。
神经性厌食症期间对营养不良耐受性的医学监测首先是临床监测，因为血液学和生物学参数在很长一段时间内保持正常。我们研究中发现的心脏并发症似乎更多地与体重减轻的快速速率有关，而不是与体重减轻的量本身有关。
