【摘要】 目的　提高对神经性厌食 (AN)患者的临床特点、内分泌功能改变及其预后情况的认识。方法　分析 2 8例AN患者的临床资料、内分泌激素水平的变化 ,并进行随访 ;研究 13例不同治疗阶段的AN患者瘦素水平变化。结果　 (1)大多数AN患者为年轻女性 (92 .9% ,2 6/2 8) ,发病年龄 (19.4± 3 .8)岁 ,病程4个月～ 7年 ;(2 )临床特点主要为厌食、消瘦和闭经 ;(3 ) 2 4例患者下丘脑 垂体 性腺轴 (HPG)功能显著下降 ,12例患者下丘脑 垂体 肾上腺轴 (HPA)功能亢进 ,9例患者甲状腺功能减退 ;(4 )AN患者 (n =9)血清瘦素水平较正常对照组 (n =2 6)显著降低〔(1.2 1± 0 .3 6vs 7.70± 4.15 ) μg/L ,P <0 .0 0 1〕 ;(5 )接受随访的患者共 2 2例 ,其中痊愈 9例 ,好转 5例 ,无效 7例 ,死亡 1例。结论　显著的体重减轻和闭经是AN患者的主要临床特征 ,伴有严重的下丘脑 垂体功能紊乱 ,瘦素水平明显下降 ,在治疗后有所上升 ,仅 40 .9%的患者经综合治疗后痊愈。更多还原

【Abstract】 Objective To improve the awareness of clinical manifestation, endocrine changes and prognosis in patients with anorexia nervosa (AN). Methods The clinical features and endocrine functions of 28 patients with AN were analysed, and the prognosis was based on the results of 4 months-7 years follow-up of these patients. The change of serum leptin level was observed during different therapeutic periods in 13 patients. Results Most of AN patients were young women (92.9%, 26/28), age of onset was (19.4±3.8)years old and the duration of follow-up was from 4 months to 7 years. Self-starvation, extreme weight loss and amenorrhoea were the characteristic manifestations. This investigation discovered 24 patients with hypofunctional hypothalamus-pituitary-gonad axis, 12 with hyperfunctional hypothalamus-pituitary-adrenal axis, 9 with decreased levels of thyroid hormones, 2 with increased level of GH (n=10), 8 with decreased level of IGF-Ⅰ (n=10). Leptin levels in AN patients (n=9) weresignificantlydecreasedascomparedwiththecontrol group (n=26) 〔(1.21±0.36 vs 7.70±4.15)μg/L, P<0.001)〕. During 4 months-7 years follow up, one patient died due to the cause directly related to AN, nine patients fully recovered, 5 patients partially recovered, and 7 still remain symptomatic. Conclusion AN is a serious eating disorder characterized by self-starvation, extreme weight loss and amenorrehea, accompanied with serious disorder in hypothelamus-pituitary function. Serum leptin levels in AN patients decreased significantly, but increased after partial recovery. Only 40.9% of patients fully recovered during the follow-up period.更多还原