目的：近年来,我国青少年饮食障碍的发病呈现上升趋势,但是由临床儿科医师进行的有关病因、诊治和转归的研究报告却很少见,该文旨在分析本组青少年饮食障碍患者的病因,探讨临床儿科医生如何进行识别和治疗。方法：研究对象来自2003年1月至2005年9月在该院诊断并治疗的6例青少年饮食障碍患者,其中5女1男,发病年龄12.4～15.8岁,来该院就诊时年龄为12.9～16.7岁,病程3～12个月不等,体块指数(BMI)9.07～17.0,4例病情严重,发生低体温、低血压、心率缓慢,脱水和多系统受损予住院治疗,另2例在门诊诊治。最终根据病史、体格检查及实验室检查结果,5例诊断为神经性厌食症,1例为神经性暴食症。结果：由儿内科医师、营养师、精神科医师和护士组成的医疗小组协同工作,对于生命体征不稳定的患者,首先着重于维持生命安全,给予静脉营养并强制卧床,同时实施认知行为疗法,帮助患者分析与发病相关的自身及环境因素,建立健康体重理念,纠正异常饮食行为。对于存在严重体像扭曲,治疗阻抗大的患者,同时给予精神类药物治疗。经治疗后,其中3例建立了健康的饮食行为,体重逐渐恢复,随访1年未复发,3例仍有一些异常饮食行为,体重始终低于正常。结论：青少年饮食障碍患者的发病可受到其成长环境中某些因素的触发,如同伴评价,时尚潮流,学业压力,沟通困难等。他们获诊时往往病程长,病情严重,预后差。儿科医师应提高对该病的认识,使患者得到早期诊断和干预,并通过多专业队伍的协同工作,提高疗效。

The occurrence of eating disorders in Chinese adolescents is increasing. However the cause, diagnosis, treatment and prognosis of this disorder are rarely reported by pediatricians. This paper investigated the cause and treatment of six cases of eating disorders in adolescent patients. The medical data of six cases of eating disorders in the Shanghai Children's Medical Center from January 2003 to September 2005 were retrospectively reviewed. The patients were 5 girls and 1 boy, whose onset ages ranged from 12.4 to 15.8 years. They were initially referred to the clinic between 12.9 to 16.7 years, with a course of disease varying from three to twelve months. The patients' body mass index (BMI) varied from 9.07 to 17.0. Four out of the six patients were hospitalized because of low temperature, low blood pressure, bradycardia, dehydration and multiple systems damages. The other two were treated in the out-patient clinic. Based on the medical history and physical examination as well as laboratory findings, five of them were diagnosed with anorexia nervosa and the other one were bulimia nervosa. All of the patients were under the care of a team consisting of pediatricians, dietitians, psychiatrists and nurses. When the patients whose vital signs were unstable, medical treatment focused on life sustention and they were kept on beds compulsively and given nutrition transfusion. Meanwhile cognition and behavior therapy was administered to help the patients find out the internal and environmental factors related to the development of this disorder, establish a new conception of healthy weight, and correct their abnormal eating behaviors. The patients who had a severe distortion of body image and a big resistance to the treatment were additionally administered with psychiatry drugs. After treatment, three patients set up a healthy eating behavior, their body weights gradually recovered and they had no relapse during a 1-year follow-up. The other three patients retained some abnormal eating behaviors and their body weights were always below normal. It was found that eating disorders in adolescents may be triggered by some environmental factors, such as comments on body shape from their peers, fashion influence, academic pressures, and problems in communication. Since the patients' abnormal eating behaviors were masked or neglected by parents at the early stage of the disease and the clinical presentations were related to multiple systems, it is difficult to make an early diagnosis and treatment. It is important to improve the pediatricians' knowledge of eating disorders of adolescents and perform cooperation between a multidisciplinary team for the early diagnosis and treatment of this disorder.