Lemille J, Le Bras M, Fauconnier M, Grall-Bronnec M
Service d'addictologie et de psychiatrie de liaison, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France; Service d'addictologie, CHS, Le Pont Piétin, 44130 Blain, France.
Service d'endocrinologie, diabétologie et nutrition, hôpital Saint-Jacques, CHU, 85, rue Saint-Jacques, 44093 Nantes, France.
Rev Med Interne. 2021 Aug;42(8):558-565. doi: 10.1016/j.revmed.2020.12.010. Epub 2021 Jan 16.
Abnormalities of hematological and biochemical parameters are various and frequent during anorexia nervosa, and are mainly related to malnutrition, weight loss, and compensatory purgative behaviors. They are most often moderate and reversible through appropriate nutritional and weight rehabilitation, as well as well-conducted symptomatic treatment. Severe abnormalities are rarer, but are potentially serious or even fatal. Isolated moderate anemia and leukopenia are frequently noted, with thrombocytopenia being less frequent. Severe, bi-cytopenic, pancytopenic, and spinal cord injury are less common. They can be explained by the gelatinous transformation of the bone marrow caused by malnutrition. Biochemical abnormalities are typically hydroelectrolytic disorders (hypokalemia, hyponatremia, metabolic alkalosis), acute or chronic renal failure, elevated transaminases, risk of potentially severe hypoglycemia, and elevated lipid parameters. During the refeeding syndrome, hypophosphatemia is characteristic and may be associated with hypomagnesemia and hypocalcemia, and thiamine deficiency. Malnutrition can also lead to alterations in hormone status, including hypothyroidism, hypercorticism and hypogonadism, which may be involved in the development of serious bone conditions such as osteoporosis. These abnormalities should be routinely investigated, monitored, and corrected during anorexia nervosa. Early and multidisciplinary management of this eating disorder is essential to prevent chronicity of the disorder and the potential severity of these abnormalities.
神经性厌食症期间血液学和生化指标异常多样且常见,主要与营养不良、体重减轻及代偿性导泻行为有关。这些异常大多为中度,通过适当的营养和体重康复以及合理的对症治疗可逆转。严重异常较为少见,但可能严重甚至致命。孤立性中度贫血和白细胞减少较为常见,血小板减少相对少见。严重的双系血细胞减少、全血细胞减少和脊髓损伤则较少见。这可由营养不良导致的骨髓胶样变性来解释。生化异常通常为水电解质紊乱(低钾血症、低钠血症、代谢性碱中毒)、急性或慢性肾衰竭、转氨酶升高、潜在严重低血糖风险及血脂参数升高。在再喂养综合征期间,低磷血症具有特征性,可能伴有低镁血症、低钙血症及硫胺素缺乏。营养不良还可导致激素状态改变,包括甲状腺功能减退、皮质醇增多症和性腺功能减退,这些可能与骨质疏松等严重骨骼疾病的发生有关。在神经性厌食症期间,应常规对这些异常进行检查、监测和纠正。对这种饮食失调症进行早期多学科管理对于预防该疾病的慢性化及这些异常的潜在严重性至关重要。