神经性厌食儿童青少年出院后1～5年的随访研究

Follow-up study of children and adolescents with anorexia nervosa after 1～5 years hospital discharge

目的 随访出院神经性厌食儿童青少年的临床结局,了解其短期预后情况及其影响因素。方法选取2008-2012年首次住院治疗、符合国际疾病分类第10版神经性厌食诊断标准、年龄≤18岁的病例,采用自编的随访调查问卷从首次住院病历中提取既往病情等相关资料,并通过电话联系进行随访。结果 符合入组标准的患者共59例,共随访到45例,随访时年龄（16.56±2.52）岁,随访距出院时间（2.39±1.01）年,随访时体质指数9.21∽28.40（18.47±3.54）kg/m2,28例患者体质指数恢复正常范围,25例患者存在怕胖心理,5例患者存在体像障碍,25例患者存在异常进食行为,4例患者存在过度运动,19例（57.58%）女性患者月经正常。38例患者在正常上学或工作。客观评定痊愈13例,好转28例,迁延不愈4例;主观评定疗效好25例,中等13例,差7例;主观评定结果优于客观评定结果（Kappa=0.214）。以客观结局做分析,男性性别与预后呈正相关（r=0.311,P=0.037）,病前性格中的“好强”特点与预后呈负相关（r=-0.317,P=0.034）。结论 神经性厌食儿童青少年住院治疗后1∽5年总体预后较好,男性患者的预后优于女性患者,病前性格好强的患者预后相对更差。

Objective To investigate the short-term prognosis of discharged children and adolescents with anorexia nervosa and explore the factors related with clinical outcome. Method Cases with age 418 years old,meeting criteria of anorexia nervosa of International Classification of Disease, 10th version（ICD-10） and hospitalized firstly during 2008 to 2012 were selected and performed by the self-compiled questionnaire to getting information from medical documents during hospi- talization and telephone follow-up. Results In the 59 enrolled subjects,45 cases with average age of 16.56 years old were followed up after average 2.39 years from their discharge. At the follow-up,their body mass index （BMI） was 9.21--28.40 （18.47＋3.54） kg/m2 ,the BMI of 28 cases had already been normal,25 cases had fear of being fat,5 cases had body-lmage disorder, 25 cases had abnormal eating behaviors, 4 cases had excessive exercise, 19 （57. 58% ）cases of the female patients had normal menstruation,38 cases were at school or work normally. In objective assessment of outcome, the numbers of cases with recovery,improvement and chronicity were 13,28 and 4 respectively. In the subjective assessment of outcome, the numbers of cases with good,middle and poor outcome were separately 23,13 and 7 respectively. The results of subjective as- sessment were better than that of objective assessment（Kappa=0. 214）. Based on the results of objective assessment,male was positively correlated with the prognosis（r=0. 311 ,P=0. 037） ,the competitive of subject was negatively correlated with prognosis（r=-0. 317,P〈0. 034）. Conclusions The outcome of children and adolescents with anorexia nervosa during 1- 5 years after hospital discharge is relatively good. The prognosis of boys is better than girls,and the competitive nature may affect the clinical outcome negatively.