Funayama Michitaka, Koreki Akihiro, Mimura Yu, Takata Taketo, Ogino Satoyuki, Kurose Shin, Shimizu Yusuke, Kudo Shun
Department of Neuropsychiatry, Ashikaga Red Cross Hospital, 284-1 Yobe, Ashikaga, Tochigi, 326-0843, Japan.
Department of Neuropsychiatry, Keio University School of Medicine, Shinjuku, Tokyo, Japan.
J Eat Disord. 2022 May 5;10(1):64. doi: 10.1186/s40337-022-00586-x.
Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period.
We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake.
The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 10/μl decreased by 24.3% to 171 ± 80 × 10/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion.
Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.
尽管神经性厌食症患者的血液学异常已有文献记载，但其涉及的机制尚未完全阐明，尤其是在重新进食期间，血液学指标在入院后进一步下降，随后才有所改善。在此，我们探讨神经性厌食症住院患者在重新进食期间血液学异常的潜在机制。
我们从1999年10月至2018年3月期间足立红十字医院神经精神科收治的101例住院患者中招募了55例患有严重营养不良（体重指数，13.4±3.4）的神经性厌食症患者。我们分析了三项血液学细胞指标，即血红蛋白、白细胞计数和血小板计数，以确定其入院时的水平以及重新进食期间的最低水平，并计算这些值从入院到最低点水平的下降百分比。我们使用一般混合模型分析每项指标，模型中的解释变量包括入院时的数据和一个与治疗相关的指标，即能量摄入。
初始血红蛋白值为12.1±2.7g/dl，下降22.3%至9.4±2.5g/dl；初始白细胞计数为5387±3474/μl，下降33.6%至3576±1440/μl；初始血小板计数为226±101×10/μl，下降24.3%至171±80×10/μl。所有最低点水平均在住院第5至10天的重新进食期间观察到。发现三项血液学细胞指标之间存在显著相关性，尤其是在最低点水平时。值得注意的是，我们41.7%在住院期间接受红细胞输血的患者入院时血红蛋白水平正常。神经性厌食症限制型与白细胞计数的最低点水平较低有关。感染性并发症与血红蛋白的最低点水平较低、血红蛋白水平下降百分比更大以及红细胞输血需求有关。
神经性厌食症住院患者血液学细胞指标的最低点可能可通过限制型和感染性并发症来预测。神经性厌食症限制型与重新进食期间血液学指标的进一步下降有关。
