Golden N H, Jacobson M S, Schebendach J, Solanto M V, Hertz S M, Shenker I R
Department of Pediatrics, Schneider Children's Hospital, Long Island Jewish Medical Center, Albert Einstein College of Medicine, New Hyde Park, NY, USA.
Arch Pediatr Adolesc Med. 1997 Jan;151(1):16-21. doi: 10.1001/archpedi.1997.02170380020003.
To determine factors associated with resumption of menses (ROM) in adolescents with anorexia nervosa.
Cohort study with 2-year follow-up.
Tertiary care referral center.
Consecutive sample of 100 adolescent girls with anorexia nervosa.
Body weight, percent body fat, and luteinizing hormone, follicle-stimulating hormone, and estradiol levels were measured at baseline and every 3 months until ROM (defined as 2 or more consecutive spontaneous menstrual cycles). Treatment consisted of a combination of medical, nutritional, and psychiatric intervention aimed at weight gain and resolution of psychological conflicts.
Body weight, body composition, and hormonal status at ROM.
Menses resumed at a mean (+/-SD) of 9.4 +/- 8.2 months after patients were initially seen and required a weight of 2.05 kg more than the weight at which menses were lost. Mean (+/-SD) percent of standard body weight at ROM was 91.6% +/- 9.1%, and 86% of patients resumed menses within 6 months of achieving this weight. At 1-year follow-up, 47 (68%) of 69 patients had resumed menses and 22 (32%) remained amenorrheic. No significant differences were seen in body weight, body mass index, or percent body fat at follow-up in those who resumed menses by 1 year compared with those who had not. Subjects who remained amenorrheic at 1 year had lower levels of luteinizing hormone (P < .001) and follicle-stimulating hormone (P < .05) at baseline and lower levels of luteinizing hormone (P < .01) and estradiol (P < .001) at follow-up. At follow-up, a serum estradiol level of more than 110 pmol/L (30 pg/mL) was associated with ROM (relative risk, 4.6; 95% confidence interval, 1.9-11.2).
A weight approximately 90% of standard body weight was the average weight at which ROM occurred and is a reasonable treatment goal weight, because 86% of patients who achieved this goal resumed menses within 6 months. Resumption of menses required restoration of hypothalamic-pituitary-ovarian function, which did not depend on the amount of body fat. Serum estradiol levels at follow-up best assess ROM.
确定神经性厌食青少年月经恢复（ROM）的相关因素。
为期2年随访的队列研究。
三级医疗转诊中心。
100例神经性厌食青少年女孩的连续样本。
在基线时以及每3个月测量一次体重、体脂百分比、促黄体生成素、促卵泡激素和雌二醇水平，直至月经恢复（定义为连续2个或更多个自发月经周期）。治疗包括医学、营养和心理干预相结合，旨在增加体重并解决心理冲突。
月经恢复时的体重、身体成分和激素状态。
患者首次就诊后平均（±标准差）9.4±8.2个月月经恢复，恢复月经时的体重比月经初潮时的体重多2.05kg。月经恢复时标准体重的平均（±标准差）百分比为91.6%±9.1%，86%的患者在达到此体重后的6个月内恢复月经。在1年随访时，69例患者中有47例（68%）恢复月经，22例（32%）仍闭经。与未恢复月经的患者相比，1年内恢复月经的患者在随访时的体重、体重指数或体脂百分比无显著差异。1年时仍闭经的患者在基线时促黄体生成素（P<0.001）和促卵泡激素（P<0.05）水平较低，在随访时促黄体生成素（P<0.01）和雌二醇（P<0.001）水平较低。随访时，血清雌二醇水平超过110pmol/L（30pg/mL）与月经恢复相关（相对危险度，4.6；95%可信区间，1.9 - 11.2）。
约为标准体重90%的体重是月经恢复时的平均体重，是一个合理的治疗目标体重，因为86%达到此目标的患者在6个月内恢复月经。月经恢复需要下丘脑 - 垂体 - 卵巢功能的恢复，这并不取决于体脂量。随访时的血清雌二醇水平最能评估月经恢复情况。
