初始高热量再喂养方案治疗青少年神经性厌食症的疗效和安全性Meta分析  

Meta-analysis of the clinical effectiveness and safety of initial high-calorie refeeding for the treatment of adolescent anorexia nervosa

作　　者：刘敏[1,2] 田婉 王素梅[2] 曲彦[2] 关纯[2] Liu Min;Tian Wan;Wang Sumei;Qu Yan;Guan Chun(School of Nursing,Qingdao University,Qingdao266071,China;Department of Critical Care Medicine,Qingdao Hospital,University of Health and Rehabilitation Sciences-Qingdao Municipal Hospital,Qingdao266071,China)

机构地区：[1]青岛大学护理学院,青岛266071 [2]康复大学青岛医院-青岛市市立医院重症医学科,青岛266071

出　　处：《中华临床营养杂志》2024年第6期338-346,共9页Chinese Journal of Clinical Nutrition

基　　金：国家自然科学基金(82202384)。

摘　　要：目的探讨高热量再喂养(high-calorie refeeding,HCR)方案治疗青少年神经性厌食症(anorexia nervosa,AN)的疗效和安全性。方法计算机检索PubMed、Embase、Web of Science、Cochrane Library、中国知网、万方数据库、维普中文科技期刊数据库、中国生物医学文献数据库中关于HCR方案治疗青少年AN临床疗效和安全性的临床试验研究,包括随机对照试验和类实验研究。检索时限为建库至2023年10月20日。由两名研究者独立进行文献筛选、资料提取及文献质量评价,应用Rev Man 5.4软件进行Meta分析。结果共纳入8篇文献,涉及1145例青少年AN患者,其中,HCR组604例,低热量再喂养组541例。Meta分析结果显示,HCR组患者的体重增加高于低热量再喂养组患者,但差异无统计学意义(SMD=0.41,95%CI-0.03~0.84,P=0.06);HCR组患者的住院时间短于低热量再喂养组患者,差异有统计学意义(MD=-4.96,95%CI-8.71~-1.20,P=0.01);两组患者再喂养低磷血症的发生率比较,差异无统计学意义(OR=0.95,95%CI 0.51~1.75,P=0.87)。结论HCR方案治疗青少年AN的临床效果良好,更有可能促进青少年AN患者体重的恢复,缩短住院时间,且不会不增加低磷血症或再喂养综合征的发病风险,具有较高的安全性和可行性。Objective To evaluate the clinical effectiveness and safety of a high-calorie refeeding(HCR)regimen for the treatment of adolescent anorexia nervosa.MethodsDatabases including PubMed,Embase,Web of Science,Cochrane Library,China National Knowledge Infrastructure,Wanfang Data,VIP,and SinoMed were searched for studies on the clinical effectiveness and safety of HCR regimens in children and adolescents with anorexia nervosa.Both randomized controlled trials and quasi-randomized controlled trials were screened.The search was limited to publications from the construction of the databases to October 20,2023.Two researchers independently conducted the literature screening,data extraction and quality assessment.Meta-analysis was performed using RevMan 5.4 software.ResultsA total of 8 studies involving 1145 patients were included.Among them,604 were in the HCR group and 541 in the low-calorie refeeding group.Meta-analysis showed that the weight gain of patients in the HCR group was higher than that in the low-calorie refeeding group,and the difference was not statistically significant(SMD:0.41,95%CI:-0.03 to 0.84,P=0.06).The length of hospitalization of patients in the HCR group was shorter than that in the low-calorie refeeding group,and the difference was statistically significant(MD:-4.96,95%CI:-8.71 to-1.20,P=0.01).The incidence of hypophosphatemia as a part of refeeding syndrome in patients in the HCR group were not statistically different compared with those in the low-calorie refeeding group(OR:0.95,95%CI 0.51 to 1.75,P=0.87).ConclusionsHCR regimens are more likely to promote weight regain and shorten hospitalization without increasing the risk of developing refeeding syndrome or hypophosphatemia.This study supports the clinical effectiveness of HCR regimens for the treatment of adolescents with anorexia nervosa,with favorable safety and feasibility in clinical practice.

关 键 词：青少年 神经性厌食症 高热量再喂养 META分析 

分 类 号：R741[医药卫生—神经病学与精神病学]