Foppiani L, Uva V, Falivene M, Valenti S, Traversa C, Rasore E, Giusti M
Cattedra di Endocrinologia, Università degli Studi, Genova.
Minerva Med. 1995 Dec;86(12):537-42.
Well known is the need to treat "acute onset" Anorexia Nervosa in care units. Nevertheless even the "successfully treated" patients show a very high percentage of relapse. The aim of our study has been to revalue different clinical, nutritional (hemoglobin, transferrin, IGF1), hormonal (thyroid function, gonadotropins) and psychiatric (EDI: Eating Disorder Inventory Test) parameters in a group of nineteen women aged 20-34 years (median 27 years) admitted to our department 1-11 years (median 6 years) before for anorexia nervosa treatment. On admission their weight loss was -33% +/- 10% according to Ideal Body Weight (IBW); a "low T3 syndrome" was present and all the patients not treated with estro-progestins were amenorrhoic. After a long hospitalization (median 51 days) the patients showed a significant decrease in weight loss (25% +/- 6%; p < 0.01). At follow-up seventeen patients had a weight better than at discharge (13% +/- 12%; p < 0.01) and 9/17 patients non treated with estro-progestins had spontaneous menses. Nutritional (hemoglobin*: 13 +/- 0.2 g%, transferrin*: 313 +/- 57 mg%, IGF-1: 187 +/- 15 ng/ml) and hormonal (LH*: 9.4 +/- 1 mUI/ml, FSH*: 15 +/- 1.3 mUI/ml, T3: 1 +/- 1 ng/ml) parameters were significantly improved (*p < 0.01, p < 0.05) compared to those at admission (hemoglobin: 12 +/- 0.2 g%, transferrin: 218 +/- 58 mg%, IGF-1: 154 +/- 21 ng/ml, LH: 5.6 +/- 0.8 mUI/ml, FSH: 9.5 +/- 1 mUI/ml, T3: 0.8 +/- 1 ng/ml). The EDI test has shown a persistence of anorexic condition ("overt" or latent) in 2/3 of patients. This study confirms the endocrine and nutritional modifications of anorexia nervosa and underlines the persistence of psychiatric ones in a great number of patients including the "clinically cured", justifying long-term follow-up and the high percentage of disease relapse.
在护理单元中治疗“急性起病”的神经性厌食症的必要性是众所周知的。然而，即使是“成功治疗”的患者也有很高的复发率。我们研究的目的是重新评估一组19名年龄在20 - 34岁（中位数27岁）的女性的不同临床、营养（血红蛋白、转铁蛋白、胰岛素样生长因子1）、激素（甲状腺功能、促性腺激素）和精神（饮食失调问卷测试）参数，这些女性在1 - 11年前（中位数6年）因神经性厌食症治疗而入住我们科室。入院时，根据理想体重（IBW），她们的体重减轻了-33% +/- 10%；存在“低T3综合征”，所有未接受雌激素 - 孕激素治疗的患者均闭经。经过长时间住院（中位数51天），患者体重减轻显著下降（25% +/- 6%；p < 0.01）。在随访中，17名患者的体重比出院时更好（13% +/- 12%；p < 0.01），9/17名未接受雌激素 - 孕激素治疗的患者出现自发月经。与入院时相比（血红蛋白：12 +/- 0.2 g%，转铁蛋白：218 +/- 58 mg%，胰岛素样生长因子1：154 +/- 21 ng/ml，促黄体生成素：5.6 +/- 0.8 mUI/ml，促卵泡生成素：9.5 +/- 1 mUI/ml，T3：0.8 +/- 1 ng/ml），营养（血红蛋白*：13 +/- 0.2 g%，转铁蛋白*：313 +/- 57 mg%，胰岛素样生长因子 - 1：187 +/- 15 ng/ml）和激素（促黄体生成素*：9.4 +/- 1 mUI/ml，促卵泡生成素*：15 +/- 1.3 mUI/ml，T3：1 +/- 1 ng/ml）参数显著改善（*p < 0.01，p < 0.05）。饮食失调问卷测试显示，2/3的患者存在厌食状况（“明显”或潜在）。这项研究证实了神经性厌食症的内分泌和营养改变，并强调了包括“临床治愈”患者在内的大量患者中精神方面的持续存在，这证明了长期随访的合理性以及疾病的高复发率。
