Herzog W, Deter H C, Fiehn W, Petzold E
Department of Internal Medicine 2 (General Internal and Psychosomatic Medicine), University of Heidelberg Medical Hospital, Germany.
Psychol Med. 1997 Mar;27(2):269-79. doi: 10.1017/s0033291796004394.
Patients with anorexia nervosa (AN) run a high risk of becoming chronically ill and of dying. In the acute phase of their illness they present with numerous physical and laboratory abnormalities. However, little is known about the long-term prognostic value of these findings or about the medical morbidity in large samples of consecutively treated patients in the long-term.
We evaluated 84 consecutive female patients with AN who were studied again an average of 11.9 years later. The ability of some of the laboratory data obtained at the initial examination to predict a fatal or chronic course was analysed by discriminant and multiple regression analyses.
Abnormally low serum albumin levels (< or = 36 g/l) and a low weight (< or = 60% of average body weight) at the initial examination were variables best able to predict a lethal course. In addition, high serum creatinine and uric acid levels predicted a chronic course. Most of the initial abnormal laboratory findings were reversible with a normal food intake. At a 12-year follow-up 67% of the chronic anorexic patients and 27% of those in the good/intermediate outcome group (compared to 8% morbidity in normal controls) presented with medical co-morbidity, in particular osteoporosis and renal disease. The standardized mortality ratio was 9.6.
Laboratory findings obtained at the initial examination may be helpful in predicting a fatal or chronic course of AN. An evaluation of the long-term outcome of eating disorders should include an assessment of the medical co-morbidity.
神经性厌食症（AN）患者面临着慢性疾病和死亡的高风险。在疾病急性期，他们会出现众多身体和实验室检查异常。然而，对于这些检查结果的长期预后价值以及连续接受长期治疗的大量患者的医疗发病率，我们知之甚少。
我们评估了84例连续的AN女性患者，平均在11.9年后对她们进行了再次研究。通过判别分析和多元回归分析，分析了初次检查时获得的一些实验室数据预测致命或慢性病程的能力。
初次检查时血清白蛋白水平异常低（≤36 g/L）和体重低（≤平均体重的60%）是最能预测致命病程的变量。此外，高血清肌酐和尿酸水平预测慢性病程。大多数初次异常的实验室检查结果在正常饮食摄入后是可逆的。在12年随访时，67%的慢性厌食症患者和27%预后良好/中等的患者（正常对照组发病率为8%）存在合并症，尤其是骨质疏松症和肾脏疾病。标准化死亡率为9.6。
初次检查时获得的实验室检查结果可能有助于预测AN的致命或慢性病程。饮食失调的长期结局评估应包括对合并症的评估。
