Abstract：
BACKGROUND: Although hematological abnormalities in patients with anorexia nervosa have been documented, the mechanisms involved have not been fully clarified, especially during the refeeding period when hematological values further decrease after admission prior to improving. Here we address potential mechanisms underlying the hematological abnormalities of inpatients with anorexia nervosa during the refeeding period.
METHODS: We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake.
RESULTS: The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 103/μl decreased by 24.3% to 171 ± 80 × 103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion.
CONCLUSIONS: Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.
Deficiencies in components of the blood, such as a low red blood cell count, low white blood cell count, and low platelet numbers, are observed frequently in patients with anorexia nervosa, particularly those with severe malnutrition, and these deficiencies become manifest after hospitalization during the initial period when patients are reintroduced to food. Why this deterioration occurs even under medical care is not well understood. Here we analyzed the patient factors associated with these blood cell abnormalities. Patients with the restrictive type of anorexia nervosa, and infectious complications were more likely to have the lowest levels of hematological values during the refeeding period.
METHODS: We recruited patients from 101 admissions corresponding to 55 individual patients with anorexia nervosa with severe malnutrition (body mass index, 13.4 ± 3.4) from the neuropsychiatry unit in Ashikaga Red Cross Hospital during the period from October 1999 to March 2018. We analyzed three hematological cell measures, i.e., hemoglobin, white cell count, and platelet count, to determine their levels at admission and their lowest levels during the refeeding period and calculated the percent decrease in those values from admission to the nadir levels. We analyzed each measure using a general mixed model with explanatory variables, including data upon admission and a treatment-related indicator, i.e., energy intake.
RESULTS: The initial hemoglobin value of 12.1 ± 2.7 g/dl decreased by 22.3% to 9.4 ± 2.5 g/dl; the initial white cell count was 5387 ± 3474/μl, which decreased by 33.6% to 3576 ± 1440/μl; the initial platelet count of 226 ± 101 × 103/μl decreased by 24.3% to 171 ± 80 × 103/μl. All nadir levels were observed during the refeeding period from the fifth to tenth day of hospitalization. Significant correlations among the three hematological cell measures, particularly at the nadir levels, were found. Of note, 41.7% of our patients who received red blood cell transfusion during hospitalization showed normal hemoglobin levels upon admission. The anorexia nervosa restrictive type was associated with a lower nadir level of white blood cell count. Infectious complications were related to a lower nadir level of hemoglobin and a greater percent decrease in hemoglobin level as well as to the need for red blood cell transfusion.
CONCLUSIONS: Nadir hematological cell measures of inpatients with anorexia nervosa might be predicted by the restrictive type and infectious complications. The anorexia nervosa restrictive type was associated with further decrease in hematological values during the refeeding period.
Deficiencies in components of the blood, such as a low red blood cell count, low white blood cell count, and low platelet numbers, are observed frequently in patients with anorexia nervosa, particularly those with severe malnutrition, and these deficiencies become manifest after hospitalization during the initial period when patients are reintroduced to food. Why this deterioration occurs even under medical care is not well understood. Here we analyzed the patient factors associated with these blood cell abnormalities. Patients with the restrictive type of anorexia nervosa, and infectious complications were more likely to have the lowest levels of hematological values during the refeeding period.
摘要：
背景：虽然神经性厌食症患者的血液学异常已被证实，所涉及的机制尚未完全阐明，尤其是在重新喂养期间，入院后血液学值进一步下降，然后才改善。在这里，我们探讨了在再喂养期间神经性厌食症住院患者血液学异常的潜在机制。
方法：我们从101名入院的患者中招募了55名患有严重营养不良的神经性厌食症患者（体重指数，13.4±3.4），从1999年10月至2018年3月期间，来自足益红十字会医院的神经精神科。我们分析了三种血细胞测量，即，血红蛋白,白细胞计数,和血小板计数,确定入院时的水平和再喂养期间的最低水平，并计算从入院到最低点水平这些值的下降百分比。我们使用带有解释变量的一般混合模型分析了每种度量，包括入院时的数据和与治疗相关的指标，即，能量摄入。
结果：初始血红蛋白值12.1±2.7g/dl下降22.3％，为9.4±2.5g/dl；初始白细胞计数为5387±3474/μl，下降33.6%至3576±1440/μl；初始血小板计数226±101×103/μl下降24.3%至171±80×103/μl。在住院的第5天至第10天的重新喂养期间观察到所有最低点水平。三种血细胞测量值之间存在显着相关性，特别是在最低点，被发现了。值得注意的是，在住院期间接受红细胞输血的41.7％的患者入院时血红蛋白水平正常。神经性厌食症限制性类型与白细胞计数的最低点水平较低有关。感染性并发症与血红蛋白的最低点水平较低，血红蛋白水平下降的百分比较大以及需要输注红细胞有关。
结论：神经性厌食症住院患者的血细胞水平可以通过限制性类型和感染并发症来预测。神经性厌食症限制性类型与再喂养期间血液学值的进一步降低有关。
血液成分缺乏,比如红细胞计数低，白细胞计数低,低血小板数,在神经性厌食症患者中经常观察到，特别是那些严重营养不良的人，这些缺陷在患者重新接受食物的初始阶段住院后变得明显。为什么即使在医疗保健下也会发生这种恶化还没有很好的理解。在这里，我们分析了与这些血细胞异常相关的患者因素。患有限制性神经性厌食症的患者，感染并发症更有可能在再喂养期间具有最低的血液学值。
方法：我们从101名入院的患者中招募了55名患有严重营养不良的神经性厌食症患者（体重指数，13.4±3.4），从1999年10月至2018年3月期间，来自足益红十字会医院的神经精神科。我们分析了三种血细胞测量，即，血红蛋白,白细胞计数,和血小板计数,确定入院时的水平和再喂养期间的最低水平，并计算从入院到最低点水平这些值的下降百分比。我们使用带有解释变量的一般混合模型分析了每种度量，包括入院时的数据和与治疗相关的指标，即，能量摄入。
结果：初始血红蛋白值12.1±2.7g/dl下降22.3％，为9.4±2.5g/dl；初始白细胞计数为5387±3474/μl，下降33.6%至3576±1440/μl；初始血小板计数226±101×103/μl下降24.3%至171±80×103/μl。在住院的第5天至第10天的重新喂养期间观察到所有最低点水平。三种血细胞测量值之间存在显着相关性，特别是在最低点，被发现了。值得注意的是，在住院期间接受红细胞输血的41.7％的患者入院时血红蛋白水平正常。神经性厌食症限制性类型与白细胞计数的最低点水平较低有关。感染性并发症与血红蛋白的最低点水平较低，血红蛋白水平下降的百分比较大以及需要输注红细胞有关。
结论：神经性厌食症住院患者的血细胞水平可以通过限制性类型和感染并发症来预测。神经性厌食症限制性类型与再喂养期间血液学值的进一步降低有关。
血液成分缺乏,比如红细胞计数低，白细胞计数低,低血小板数,在神经性厌食症患者中经常观察到，特别是那些严重营养不良的人，这些缺陷在患者重新接受食物的初始阶段住院后变得明显。为什么即使在医疗保健下也会发生这种恶化还没有很好的理解。在这里，我们分析了与这些血细胞异常相关的患者因素。患有限制性神经性厌食症的患者，感染并发症更有可能在再喂养期间具有最低的血液学值。
