厌食症合并窦性心动过缓1例

厌食症，即神经性厌食症，指个体通过节食等手段，有意造成并维持体重明显低于正常标准为特征的一种进食障碍，表现为体重显著减轻，合并营养不良、代谢和内分泌紊乱。2012年第5版《精神障碍的诊断与统计手册》（Diagnostic and Statistical Manual of Mental Disorders）中厌食症的诊断标准为：（1）明显的体重减轻，比正常平均体重减轻15%以上，或者克托莱（Quetelet）体质量指数为17.5 kg/m2或更低；（2） 病理性怕胖；（3）自己故意造成体重减轻［1］。窦性心动过缓是在厌食症患者心脏查体中最常见的心律失常类型，其在厌食症患者中的发病率可高达95%［2］，当厌食症患者的窦性心动过缓合并一些其他心电图异常表现（如长QT间期）时，我们需要提高警觉，注意这种心律失常可能会造成更致命的心律失常，甚至猝死。现将北京大学第三医院2014年收治的1例患者报告如下。

Anorexia with sinus bradycardia:a case report

SUMMARY Asanorexiapatientsalwaysgotothepsychiatricclinic,littleisconcernedabouttheoccur-rence of sinus bradycardia in these patients for cardiologists and psychiatrists.The aim of this paper is to discuss the relationship between anorexia and sinus bradycardia,and the feature analysis,differential diagnosis and therapeutic principles of this type of sinus bradycardia.We report a case of sinus bradycar-dia in an anorexia patient with the clinical manifestations,laboratory exams,auxiliary exams,therapeutic methods,and her prognosis,who was admitted to Peking University Third Hospital recently.The patient was a 1 9-year-old female,who had the manifestation of anorexia.She lost obvious weight in a short time (about 1 5 kg in 6 months),and her body mass index was 1 4.8 kg/m2 .The patient felt apparent palpi-tation,chest depression and short breath,without dizziness,amaurosis or unconsciousness.Vitals on presentation were notable for hypotension,and bradycardia.The initial exam was significant for emacia-tion,but without lethargy or lower extremity edema.The electrocardiogram showed sinus bradycardia with her heart rate being 32 beats per minute.The laboratory work-up revealed her normal blood routine,elec-trolytes and liver function.But in her thyroid function test,the free thyroid (FT)hormones 3 was 0.91 ng/L (2.3-4.2 ng/L),and FT4 was 8.2 ng/L(8.9 -1 8.0 ng/L),which were all lower;yet the thy-roid stimulating hormone(TSH)was normal 1 .48 IU/mL(0.55 -4.78 IU/mL).Ultrasound revealed her normal thyroid.Anorexia is an eating disorder characterized by extremely low body weight,fear of gaining weight or distorted perception of body image,and amenorrhea.Anorexia patients who lose weight appa-rently in short time enhance the excitability of the parasympathetic nerve,and inhibit the sympathetic nerve which lead to the appearance of sinus bradycardia,and functional abnormalities of multiple systems such as hypothyroidism.But this kind of sinus bradycardia and hypothyroidism have good prognosis.And asymptomatic sinus bradycardia with reversible causes,because of the great prognosis,they do not need special treatment.Multiple medical and psychiatric disciplines were consulted,and then,family care, nutritional support and psychiatric therapy were given,and she did not need thyroid hormone replacement therapy.The patient’s overall clinical status improved gradually during her hospital stay and her heart rate was recovered to 55 beats per minute.