Nagata Jason M, Park K T, Colditz Kelley, Golden Neville H
Department of Pediatrics, Stanford University, Stanford, CA; Division of Adolescent Medicine, Stanford University, Stanford, CA.
Department of Pediatrics, Stanford University, Stanford, CA; Division of Pediatric Gastroenterology, Stanford University, Stanford, CA.
J Pediatr. 2015 Feb;166(2):439-43.e1. doi: 10.1016/j.jpeds.2014.10.048. Epub 2014 Dec 2.
To analyze the prevalence, predictors, and evolution of increased liver enzymes in a large sample of adolescents hospitalized with anorexia nervosa (AN).
Electronic medical records of all subjects 10-22 years of age with AN, first admitted to a tertiary children's hospital from January 2007 to December 2012, were reviewed retrospectively. Demographic factors, anthropometric factors, initial prescribed calories, and alanine aminotransferase levels were recorded. Multivariate analysis was performed to assess the effect of sex, degree of malnutrition, and initial calories prescribed on having alanine aminotransferase ≥40 IU/L.
A total of 356 subjects met eligibility criteria (age 16.1 ± 2.4; 89.0% female; admission body mass index [BMI] 15.9 ± 1.9; admission percentage median BMI 78.2 ± 8.5), with elevated liver enzymes present in 37.0% on admission and in 41.1% at any point during the hospitalization. Lower percentage median BMI (aOR 0.96; 95% CI 0.93-0.98) and male sex (aOR 0.45; 95% CI 0.22-0.94) were significantly associated with odds of elevated liver enzymes on admission. Higher initial prescribed calories were associated with odds of elevated liver enzymes after admission (aOR 1.81; 95% CI 1.04-3.18).
In this study of AN and elevated liver enzymes, the degree of malnutrition and male sex predicted elevated liver enzymes on admission but initial prescribed calories also may be associated with elevated liver enzymes after admission in a small proportion of patients. Future research should better characterize the evolution of elevated liver enzymes in patients hospitalized with AN undergoing refeeding.
分析大量神经性厌食症（AN）住院青少年样本中肝酶升高的患病率、预测因素及演变情况。
回顾性分析2007年1月至2012年12月首次入住三级儿童医院的所有10 - 22岁AN患者的电子病历。记录人口统计学因素、人体测量学因素、初始规定热量及丙氨酸氨基转移酶水平。进行多变量分析以评估性别、营养不良程度和初始规定热量对丙氨酸氨基转移酶≥40 IU/L的影响。
共有356名受试者符合入选标准（年龄16.1±2.4；89.0%为女性；入院体重指数[BMI]15.9±1.9；入院时BMI中位数百分比78.2±8.5），入院时37.0%的患者肝酶升高，住院期间任何时间点为41.1%。较低的BMI中位数百分比（调整后比值比[aOR]0.96；95%置信区间[CI]0.93 - 0.98）和男性（aOR 0.45；95% CI 0.22 - 0.94）与入院时肝酶升高的几率显著相关。较高的初始规定热量与入院后肝酶升高的几率相关（aOR 1.81；95% CI 1.04 - 3.18）。
在这项关于AN和肝酶升高的研究中，营养不良程度和男性是入院时肝酶升高的预测因素，但初始规定热量在一小部分患者中也可能与入院后肝酶升高有关。未来的研究应更好地描述接受再喂养的AN住院患者肝酶升高的演变情况。
