Bou Khalil Rami, Souaiby Lama, Farès Nassim
Hôtel Dieu de France, Department of psychiatry, Saint Joseph University, Beirut, Lebanon.
Saint Joseph University, Department of psychiatry, Beirut, Lebanon.
Physiol Behav. 2017 Mar 15;171:13-20. doi: 10.1016/j.physbeh.2016.12.035. Epub 2016 Dec 30.
Anorexia nervosa (AN) is an eating disorder, mainly affecting women, with a lifetime prevalence of about 1%, that can run a chronic course. While an effective pharmacotherapy is lacking, it is hypothesized that the progesterone and type II glucocorticoid receptor antagonist mifepristone (RU486) might be useful, as it is well known that the hypothalamo-pituitary-adrenal axis (HPA) is activated in AN. Even if secondary to the eating disorder, an active HPA axis may contribute to maintaining the neuroendocrine, emotional and behavioral effects observed in AN. More specifically, it is suggested that the HPA axis interacts with limbic structures, including the insular and prefrontal cortices, to uphold the changes in interoceptive and emotional awareness seen in AN. As such, it is proposed that mifepristone (RU486) reverses these effects by acting on these limbic regions. In conclusion, the theoretical efficacy of mifepristone (RU486) in improving symptoms of AN should be tested in randomized clinical trials.
神经性厌食症（AN）是一种主要影响女性的饮食失调症，终生患病率约为1%，病程可能呈慢性。虽然缺乏有效的药物治疗方法，但据推测，孕激素和II型糖皮质激素受体拮抗剂米非司酮（RU486）可能有用，因为众所周知，下丘脑-垂体-肾上腺轴（HPA）在神经性厌食症中被激活。即使是继发于饮食失调，活跃的HPA轴也可能有助于维持在神经性厌食症中观察到的神经内分泌、情绪和行为影响。更具体地说，有人认为HPA轴与包括岛叶和前额叶皮质在内的边缘结构相互作用，以维持在神经性厌食症中看到的内感受和情绪意识的变化。因此，有人提出米非司酮（RU486）通过作用于这些边缘区域来逆转这些影响。总之，米非司酮（RU486）改善神经性厌食症症状的理论疗效应在随机临床试验中进行测试。
