Service d'Endocrinologie-Nutrition, CHU Le Bocage: 2, Bd du Maréchal de Lattre de Tassigny, 21000 Dijon, France.
Clin Nutr. 2012 Oct;31(5):693-8. doi: 10.1016/j.clnu.2012.02.016. Epub 2012 Mar 27.
BACKGROUND & AIMS: To report the prognosis in 41 anorexia nervosa (AN) patients suffering from very severe malnutrition (mean BMI: 10.1 ± 0.57 kg/m(2)).
Compared with 443 less malnourished AN patients, the 41 patients were older (27.8 ± 5.4 vs 22.4 ± 2.1 yrs), their AN was longer (9.6 ± 3.4 vs 5.0 ± 1.5 yrs) and more often of the restrictive subtype (P < 0.05).
In 27% of the patients, all nutritional marker levels were in normal range. All patients received a prudent tube-refeeding: energy was increased from 12 to 40 kcal/kg/day, protein from 1.0 to 1.5 g/kg/day within 10 days. During stay, 1 patient died, 2 others suffered from myocardial infarction, 2 others from acute pancreatitis, and 5 from mental confusion. Compared with the other 443 AN patients, the 40 remaining patients had worse 6-yr prognosis: 2 died (7% vs 1.2%), 29% had severe outcome (vs 10%), and only 41% recovered (vs 62%).
In AN patients with BMI < 11 kg/m(2), a prudent tube-refeeding could avoid short-term mortality, but long-term prognosis was bad.
报告 41 例患有严重营养不良（平均 BMI：10.1 ± 0.57 kg/m(2)）的神经性厌食症（AN）患者的预后情况。
与 443 例营养状况稍好的 AN 患者相比，这 41 例患者年龄更大（27.8 ± 5.4 岁比 22.4 ± 2.1 岁），AN 患病时间更长（9.6 ± 3.4 年比 5.0 ± 1.5 年），且更多为限制型（P < 0.05）。
27%的患者所有营养指标均处于正常范围。所有患者均接受了谨慎的管饲喂养：10 天内，能量从 12 千卡/公斤/天增加到 40 千卡/公斤/天，蛋白质从 1.0 克/公斤/天增加到 1.5 克/公斤/天。住院期间，1 例患者死亡，2 例患者发生心肌梗死，2 例患者发生急性胰腺炎，5 例患者出现精神错乱。与其他 443 例 AN 患者相比，其余 40 例患者的 6 年预后更差：2 例死亡（7%比 1.2%），29%有严重结局（比 10%），仅有 41%恢复（比 62%）。
对于 BMI < 11 kg/m(2)的 AN 患者，谨慎的管饲喂养可以避免短期死亡，但长期预后较差。
