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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls.
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Effects of anorexia nervosa on clinical, hematologic, biochemical, and bone density parameters in community-dwelling adolescent girls.

机译：神经性厌食症对社区居住少女的临床，血液学，生化和骨密度参数的影响。

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摘要

OBJECTIVE: Anorexia nervosa (AN) is an eating disorder that leads to a number of medical sequelae in adult women and has a mortality rate of 5.6% per decade; known complications include effects on hematologic, biochemical, bone density, and body composition parameters. Few data regarding medical and developmental consequences of AN are available for adolescents, in particular for an outpatient community-dwelling population of girls who have this disorder. The prevalence of AN is increasing in adolescents, and it is the third most common chronic disease in adolescent girls. Therefore, it is important to determine the medical effects of this disorder in this young population. METHODS: We examined clinical characteristics and performed hematologic, biochemical, hormonal, and bone density evaluations in 60 adolescent girls with AN (mean age: 15.8 +/- 1.6 years) and 58 healthy adolescent girls (mean age: 15.2 +/- 1.8 years) of comparable maturity. Nutritional and pubertal status; vital signs; a complete blood count; potassium levels; hormonal profiles; bone density at the lumbar and lateral spine; total body, hip, and femoral neck (by dual-energy x-ray absorptiometry) and body composition (by dual-energy x-ray absorptiometry) were determined. RESULTS: All measures of nutritional status such as weight, percentage of ideal body weight, body mass index, lean body mass, fat mass, and percentage of fat mass were significantly lower in girls with AN than in control subjects. Girls with AN had significantly lower heart rates, lower systolic blood pressure, and lower body temperature compared with control subjects. Total red cell and white cell counts were lower in AN than in control subjects. Among girls with AN, 22% were anemic and 22% were leukopenic. None were hypokalemic. Mean age at menarche did not differ between the groups. However, the proportion of girls who had AN and were premenarchal was significantly higher compared with healthy control subjects who were premenarchal, despite comparable maturity as determined by bone age. Ninety-four percent of premenarchal girls with AN versus 28% of premenarchal control subjects were above the mean age at menarche for white girls, and 35% of premenarchal AN girls versus 0% of healthy adolescents were delayed >2 SD above the mean. The ratio of bone age to chronological age, a measure of delayed maturity, was significantly lower in girls with AN versus control subjects and correlated positively with duration of illness and markers of nutritional status. Serum estradiol values were lower in girls with AN than in control subjects, and luteinizing hormone values trended lower in AN. Levels of insulin-like growth factor-I were also significantly lower in girls with AN. Estradiol values correlated positively with insulin-like growth factor-I, a measure of nutritional status essential for growth (r = 0.28). All measures of bone mineral density (z scores) were lower in girls with AN than in control subjects, with lean body mass, body mass index, and age at menarche emerging as the most important predictors of bone density. Bone density z scores of <-1 at any one site were noted in 41% of girls with AN, and an additional 11% had bone density z scores of <-2. CONCLUSIONS: A high prevalence of hemodynamic, hematologic, endocrine, and bone density abnormalities are reported in this large group of community-dwelling adolescent girls with AN. Although a number of these consequences of AN are known to occur in hospitalized adolescents, the occurrence of these findings, including significant bradycardia, low blood pressure, and pubertal delay, in girls who are treated for AN on an outpatient basis is of concern and suggests the need for vigilant clinical monitoring, including that of endocrine and bone density parameters.
机译：目的：神经性厌食症（Anorexia nervosa，AN）是一种饮食失调症，在成年女性中引起许多医学后遗症，每十年的死亡率为5.6％;已知的并发症包括对血液，生化，骨密度和身体组成参数的影响。很少有关于AN的医学和发育后果的数据可用于青少年，尤其是患有这种疾病的女孩的门诊社区居民。在青少年中，AN的患病率呈上升趋势，是少女中第三种最常见的慢性疾病。因此，重要的是确定这种疾病在这个年轻人群中的医疗效果。方法：我们检查了60例患有AN（平均年龄：15.8 +/- 1.6岁）的少女和58例健康正常少女（平均年龄：15.2 +/- 1.8岁）的临床特征并进行了血液学，生化，激素和骨密度评估）。营养和青春期状态;生命体征全血细胞计数;钾水平;荷尔蒙概况;腰椎和外侧脊柱的骨密度;确定了全身，髋部和股骨颈（通过双能X线骨密度仪）和身体成分（通过双能X线骨密度仪）。结果：患有AN的女孩的所有营养状况指标（例如体重，理想体重百分比，体重指数，瘦体重，脂肪量和脂肪量百分比）均显着低于对照组。与对照组相比，患有AN的女孩的心率，收缩压和体温均显着降低。 AN中的红细胞和白细胞总数低于对照组。在患有AN的女孩中，贫血的占22％，白细胞减少的占22％。没有人是低钾血症。两组之间初潮的平均年龄没有差异。然而，尽管由骨龄确定的成熟度相当，但患有AN并处于月经前期的女孩比例比处于月经前期的健康对照受试者要高得多。 94％的AN的月经前女孩与28％的月经前对照者相比，白人女孩的月经初潮高于平均年龄，而35％的月经前AN女孩与0％的健康青少年的平均年龄延迟了> 2 SD。与对照组相比，患有AN的女孩的骨龄与时间年龄的比值（延迟成熟的量度）显着较低，并且与疾病持续时间和营养状况指标呈正相关。患有AN的女孩的血清雌二醇值比对照组的要低，而促黄体生成激素的值在AN中有降低的趋势。在患有AN的女孩中，胰岛素样生长因子I的水平也显着降低。雌二醇值与胰岛素样生长因子-I（一种生长必需的营养状况的量度）呈正相关（r = 0.28）。患有AN的女孩的所有骨矿物质密度（z分数）均低于对照组，瘦体重，体重指数和初潮年龄是骨密度的最重要预测指标。 41％患有AN的女孩在任何一个部位的骨密度z得分均<-1，另外11％的骨密度z得分<-2。结论：在这一社区居住的青少年AN中，这一群体的血液动力学，血液学，内分泌和骨密度异常的发生率很高。尽管已知许多这些后果会在住院的青少年中发生，但在门诊接受AN治疗的女孩中，这些发现的发生，包括明显的心动过缓，血压降低和青春期延迟，令人关注并建议需要保持警惕的临床监测，包括内分泌和骨密度参数。

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