Seidel Maria, Markmann Jensen Signe, Healy Darren, Dureja Aakriti, Watson Hunna J, Holst Birgitte, Bulik Cynthia M, Sjögren Jan Magnus
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, 171 65 Solna, Sweden.
Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, Technische Universität Dresden, 1099 Dresden, Germany.
Nutrients. 2021 Feb 23;13(2):709. doi: 10.3390/nu13020709.
Anorexia nervosa (AN) is a severe psychiatric condition associated with high mortality and chronicity. The hunt for state, trait, subtyping, and prognostic biomarkers is ongoing and the orexigenic hormone ghrelin and its different forms, acyl ghrelin and desacyl ghrelin, have been proposed to be increased in AN, especially in the restrictive subtype. A systematic literature search was performed using established databases up to 30 November 2020. Forty-nine studies met inclusion criteria for cross-sectional and longitudinal meta-analyses on total ghrelin, acyl ghrelin, and desacyl ghrelin. All forms of ghrelin were increased in the acute stage of anorexia nervosa during fasting compared to healthy controls. Previous notions on differences in ghrelin levels between AN subtypes were not supported by current data. In addition, a significant decrease in total ghrelin was observed pre-treatment to follow-up. However, total ghrelin levels at follow-up were still marginally elevated compared to healthy controls, whereas for acyl ghrelin, no overall effect of treatment was observed. Due to heterogeneity in follow-up designs and only few data on long-term recovered patients, longitudinal results should be interpreted with caution. While the first steps towards a biomarker in acute AN have been completed, the value of ghrelin as a potential indicator of treatment success or recovery status or its use in subtype differentiation are yet to be established.
神经性厌食症（AN）是一种严重的精神疾病，与高死亡率和慢性病程相关。对状态、特质、亚型和预后生物标志物的探索仍在进行中，促食欲激素胃饥饿素及其不同形式，即酰基胃饥饿素和去酰基胃饥饿素，被认为在AN中升高，尤其是在限制型亚型中。使用已建立的数据库进行了系统的文献检索，截至2020年11月30日。49项研究符合关于总胃饥饿素、酰基胃饥饿素和去酰基胃饥饿素的横断面和纵向荟萃分析的纳入标准。在禁食期间，与健康对照相比，神经性厌食症急性期所有形式的胃饥饿素均升高。当前数据不支持先前关于AN亚型之间胃饥饿素水平差异的观点。此外，在治疗前到随访期间观察到总胃饥饿素显著下降。然而，与健康对照相比，随访时总胃饥饿素水平仍略有升高，而对于酰基胃饥饿素，未观察到治疗的总体效果。由于随访设计的异质性以及关于长期康复患者的数据很少，纵向结果应谨慎解释。虽然在急性AN中朝着生物标志物迈出的第一步已经完成，但胃饥饿素作为治疗成功或恢复状态的潜在指标的价值或其在亚型区分中的应用尚未确定。
