进食障碍患者临床表现的性别差异分析

Gender differences of clinical manifestations in patients with eating disorders

目的探究进食障碍患者体重指数、进食相关行为及心理特征等方面的性别差异。方法纳入2008年8月至2015年11月就诊于北京大学第六医院的986例进食障碍患者,其中男54例,女932例。采用进食障碍问卷(Eating Disorder Questionnaire,EDQ)及进食障碍调查量表-1(Eating Disorder Inventory-1,EDI-1)进行进食障碍相关临床表现的横断面调查。使用1∶4的倾向性评分匹配消除年龄及诊断亚型对进食障碍患者症状表现的潜在影响。采用t检验、秩和检验、卡方检验比较男女进食障碍患者EDQ项目数据和EDI-1评分差异。使用多重线性回归进一步验证症状的性别差异。通过网络分析进食障碍患者最为重要的症状并进行性别间的比较。结果(1)匹配后男女患者分别为54例和213例,两者在年龄(t=-0.02)及诊断亚型构成(χ^(2)=0.28)方面差异无统计学意义(均P>0.05)。(2)男女进食障碍患者期望体重指数与目前体重指数的差值差异有统计学意义[1.3(-0.6,3.2)kg/m^(2)与-0.3(-2.3,2.4)kg/m^(2);Z=-2.64,P<0.01],男性患者期望体重高于目前体重,女性患者期望体重低于目前体重。(3)男性进食障碍患者选择减少主食作为节食方式的比例较女性患者小[41.5%(17/41)与63.2%(117/185);χ^(2)=6.60,P=0.010]。(4)男性进食障碍患者对瘦的追求和内省因子分均低于女性患者(Z=-3.19、-2.26,均P<0.05)。(5)在控制一般资料以及其他因子分后,性别对对瘦的追求因子分影响有统计学意义(β=3.10,P<0.001)。(6)网络分析显示,男女进食障碍患者的核心节点均为内省和对瘦的追求,与总体进食障碍群体一致。结论男性进食障碍患者的瘦身动机弱于女性,在症状网络中其最重要的症状为内省和对瘦的追求,这可能与女性相似。

Objective To explore the gender differences in body mass index(BMI),behavioral symptoms,and psychological characteristics in patients with eating disorders(ED).Methods A total of 986 ED patients,including 54 males and 932 females,who visited the Peking University Sixth Hospital from August 2008 to November 2015 were included in the study.A cross-sectional survey of ED-related clinical manifestations was conducted using the Eating Disorder Questionnaire(EDQ)and the Eating Disorder Inventory-1(EDI-1).A 1∶4 propensity score matching was utilized to eliminate the potential effects of age and diagnostic category on the symptom presentation of ED patients.To further validate gender differences in symptoms,multiple linear regression was conducted.T-tests,rank sum tests,and chi-square tests were used to compare EDQ item data and EDI-1 scores between male and female ED patients.Network analysis was employed to identify the most critical symptoms of ED patients and compare them between genders.Results After matching,54 male and 213 female patients were included in the analysis.There were no statistically significant differences in age(t=-0.02)and diagnostic composition(χ^(2)=0.28)between the groups(all P>0.05).The difference between desired and current BMI was significantly different between genders(1.3(-0.6,3.2)kg/m^(2) for males vs.-0.3(-2.3,2.4)kg/m^(2) for females;Z=-2.64,P<0.01),with males desiring a higher weight and females a lower weight.Fewer male ED patients chose to reduce staple food intake as a dieting method compared to females(41.5%(17/41)vs.63.2%(117/185);χ^(2)=6.60,P=0.010).Males had lower scores than females for Drive for Thinness and Interoceptive Awareness(Z=-3.19,-2.26,respectively;all P<0.05).After controlling for demographic variables and other factor scores,gender was found to significantly influence the Drive for Thinness factor score(β=3.10,P<0.001).Network analysis revealed that the core nodes for both male and female ED patients were Drive for Thinness and Interoceptive Awareness,consistent with the entire sample.Conclusions Male ED patients exhibited a weaker motivation for thinness compared to female patients.In the symptom network analysis,Drive for Thinness and Interoceptive Awareness were identified as the most significant symptoms for both genders.