Faculté de Médecine, Université de Paris Descartes, Paris, France.
Institute of Psychiatry and Neuroscience of Paris (IPNP), Université de Paris, INSERM UMR-S 1266, Paris, France.
Eur Eat Disord Rev. 2021 Jul;29(4):634-644. doi: 10.1002/erv.2830. Epub 2021 Apr 21.
Predictive values of acute phase metabolic abnormalities of anorexia nervosa (AN) have seldom been studied. As early postrestoration weight loss is associated with poor outcome, discharge biologic parameters were assessed to detect an association with 2-month follow-up weight loss as a proxy to poor outcome.
Fasting plasma levels of leptin, acyl-ghrelin, obestatin, PYY, oxytocin and BDNF were measured in 26 inpatients, at inclusion, at discharge and 2 months later. A body mass index less than 18 2-month postdischarge was considered a poor outcome.
Nineteen patients (73%) had a fair outcome and seven (27%) had a poor one with a mean loss of 0.69 versus 4.54 kg, respectively. Only discharge leptin levels were significantly higher in fair versus poor outcome patients (14.1 vs. 7.0 ng/ml, p = 0.006). The logistic regression model using discharge leptin, acyl-ghrelin, obestatin, oxytocin, PYY and BDNF levels as predictors of outcome disclosed a nearly significant effect of leptin (p < 0.10). Receiver operating characteristic analysis showed 11.9 ng/ml was the best value of threshold. Neither clinical variables differed according to outcome.
Leptin level may be a biomarker of early weight relapse after acute inpatient treatment of AN. Its clinical usefulness in monitoring care in AN should further be determined.
厌食症（AN）急性期代谢异常的预测价值很少被研究。由于早期恢复后体重减轻与不良结局相关，因此评估出院时的生物学参数，以发现其与 2 个月随访时体重减轻（作为不良结局的替代指标）的关联。
在 26 名住院患者中，分别在入院时、出院时和 2 个月后测量禁食血浆中瘦素、酰基-胃饥饿素、肥胖抑制素、PYY、催产素和脑源性神经营养因子的水平。出院后 2 个月时体重指数低于 18 被认为是不良结局。
19 名患者（73%）结局良好，7 名患者（27%）结局不良，体重分别减轻 0.69 公斤和 4.54 公斤。只有出院时的瘦素水平在结局良好与不良的患者之间存在显著差异（14.1 与 7.0ng/ml，p=0.006）。使用出院时的瘦素、酰基-胃饥饿素、肥胖抑制素、催产素、PYY 和脑源性神经营养因子水平作为结局预测因子的逻辑回归模型显示瘦素的作用几乎具有统计学意义（p<0.10）。受试者工作特征分析显示 11.9ng/ml 是最佳阈值。根据结局，临床变量没有差异。
瘦素水平可能是 AN 急性住院治疗后早期体重复发的生物标志物。其在监测 AN 护理中的临床应用价值尚需进一步确定。
