Herpertz S, Wagner R, Albers N, Blum W F, Pelz B, Langkafel M, Köpp W, Henning A, Oberste-Berghaus C, Mann K, Senf W, Hebebrand J
Clinic of Psychotherapy and Psychosomatics, University of Essen, Germany.
Horm Res. 1998;50(4):197-204. doi: 10.1159/000023274.
In anorexia nervosa, underweight results from a loss of body mass due to a restricted energy intake. Circulating leptin levels have been shown to be low in the acute stage of the disorder. We studied diurnal secretion characteristics of leptin, insulin and cortisol in a study group of anorectic patients prior to refeeding, a second study group of anorectic patients after initiation of refeeding and study groups of healthy underweight and normal-weight controls. Spontaneous secretion of leptin, insulin and cortisol was measured by drawing blood samples every 2 h for 24 h. The temporal relationships between the diurnal secretion patterns of the three hormones were assessed by cross-correlation analysis in every study group. Plasma levels of leptin and cortisol were secreted with a specific circadian rhythmicity and displayed an intricate temporal relationship in anorectic patients. Semistarvation in the non-refed patients was associated with (1) exceedingly low plasma leptin levels, (2) a qualitative alteration in the circadian rhythm of leptin and cortisol levels and (3) an alteration in the temporal coupling between cortisol and leptin. In contrast, in the patients who had gained weight, leptin levels were higher; furthermore, the diurnal pattern of leptin and the temporal relationship between leptin and cortisol were similar to controls. Increments in insulin secretion preceded those of leptin by 4-6 h in both anorectic patients and in controls. Leptin levels increased 4 h prior to those of cortisol in controls and in refed patients, whereas in the non-refed patients cortisol increased prior to leptin. Thus, anorexia nervosa leads to pronounced, albeit reversible changes in the secretion dynamics of leptin and cortisol.
在神经性厌食症中，体重过轻是由于能量摄入受限导致身体质量下降所致。在该疾病的急性期，循环中的瘦素水平已被证明较低。我们研究了未进食前的厌食症患者研究组、开始进食后的厌食症患者第二研究组以及健康体重过轻和正常体重对照组中瘦素、胰岛素和皮质醇的昼夜分泌特征。通过每2小时采集一次血样，持续24小时来测量瘦素、胰岛素和皮质醇的自发分泌。在每个研究组中，通过互相关分析评估这三种激素昼夜分泌模式之间的时间关系。在厌食症患者中，瘦素和皮质醇的血浆水平以特定的昼夜节律分泌，并呈现出复杂的时间关系。未进食患者的半饥饿状态与以下情况相关：（1）血浆瘦素水平极低；（2）瘦素和皮质醇水平昼夜节律的质性改变；（3）皮质醇和瘦素之间时间耦合的改变。相比之下，体重增加的患者瘦素水平较高；此外，瘦素的昼夜模式以及瘦素与皮质醇之间的时间关系与对照组相似。在厌食症患者和对照组中，胰岛素分泌的增加都比瘦素提前4 - 6小时。在对照组和进食后的患者中，瘦素水平比皮质醇提前4小时升高，而在未进食的患者中，皮质醇比瘦素提前升高。因此，神经性厌食症会导致瘦素和皮质醇分泌动态发生显著但可逆的变化。
