神经性厌食症患儿营养支持的临床挑战与研究进展

doi:10.12372/jcp.2026.25e1559

摘要/Abstract

摘要：

神经性厌食症（AN）是一种以刻意维持低体重为核心特征的进食障碍，其诊断率与规范化治疗率均偏低。患者长期处于营养不良状态易引发多系统严重并发症，营养支持是其治疗的核心环节。目前，临床营养支持主要包括传统低热量与高热量再喂养两种方案，其中高热量方案不仅能缩短患儿住院时间、降低医疗成本，且不会增加再喂养综合征的发生风险，但该方案在重度营养不良患儿中的适用性及长期应用影响仍需进一步探索。关于AN患儿的营养支持方案，尤其是初始能量摄入方案，国际上仍缺乏统一共识。鉴于此，本文系统梳理AN患儿的营养评估手段、营养支持策略及再喂养综合征的预防要点。研究表明，采用多维度整合评估可有效提升营养评估的精准度。

关键词: 神经性厌食, 营养不良, 营养支持, 再喂养综合征, 低磷血症, 儿童

Abstract:

Anorexia nervosa(AN) is an eating disorder characterized by the deliberate maintenance of low body weight,with both low diagnosis rate and low standardized treatment rate. Patients with long-term malnutrition are prone to severe multisystem complications, and nutritional support is the core component of their treatment. Currently, two regimens are predominantly applied in clinical nutritional support: the traditional low-calorie refeeding and high-calorie refeeding. Among them, the high-calorie refeeding regimen not only shortens the length of hospital stay and reduces medical costs, but also does not increase the risk of refeeding syndrome. However, the applicability of this regimen in children with severe malnutrition and its long-term effects require further exploration. Regarding the nutritional support regimens for children with AN, particularly the initial calorie intake regimen, there is still no unified consensus internationally. In view of this, this paper systematically reviews the nutritional assessment tools, nutritional support strategies, and key points for the prevention of refeeding syndrome in children with AN. Studies have shown that the adoption of multidimensional integrated assessment can effectively improve the accuracy of nutritional evaluation.

Key words: anorexia nervosa, malnutrition, nutritional support, refeeding syndrome, hypophosphatemia, child

中图分类号:

王李慧, 马鸣. 神经性厌食症患儿营养支持的临床挑战与研究进展[J]. 临床儿科杂志, 2026, 44(5): 478-484.

WANG Lihui, MA Ming. Clinical challenges and research progress in nutritional support for children with anorexia nervosa[J]. Journal of Clinical Pediatrics, 2026, 44(5): 478-484.

图/表 2

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	轻度营养不良	中度营养不良	重度营养不良
身高/身长别体重Z评分	-1~-1.9	-2~-2.9	≤-3
年龄别BMI Z评分	-1~-1.9	-2~-2.9	≤-3
年龄别身高/身长Z评分	无数据	无数据	≤-3
中上臂围Z评分	-1~-1.9	-2~-2.9	≤-3

	轻度营养不良	中度营养不良	重度营养不良
体重增加速度（<2岁）	低于预期理想体重增加的75%	低于预期理想体重增加的50%	低于预期理想体重增加的25%
体重下降百分比（2~20岁）	5%的体重下降	7.5%的体重下降	10%的体重下降
身高/身长别体重Z评分	下降1个Z评分	下降2个Z评分	下降3个Z评分
营养素摄入不足	51%~75%预期能量/蛋白质摄入	26%~50%预期能量/蛋白质摄入	≤25%预期能量/蛋白质摄入