儿童ADHD视听整合持续操作测验的诊断意义及与血铅、铁、锌相关研究

Clinical significance of integrated visual and auditory continuous performance test on attention deficit-hyperactivity disor- der diagnosis and its correlation with blood lead, iron &zinc.

【目的】探讨铅暴露和微量元素血锌铁与儿童注意损害之间的关系;验证视听整合持续性操作测验(integratedvisualandauditorycontinuousperformancetest,IVA-CPT)在诊断儿童注意缺陷多动障碍(attentiondeficit-hyperactivitydisorder,ADHD)上的客观意义和临床价值。【方法】应用视听整合持续性操作评估软件对一组符合DSM-Ⅳ诊断标准的多动症儿童和正常儿童进行检查。采用阳极溶出伏安法测定血中铅水平。采用全血原子吸收法测定血锌、铁。【结果】IVA-CPT诊断ADHD的敏感度为87.5％,特异度87.88％。ADHD)组与对照组相比,IVA-CPT的综合控制商数、综合注意力商数、听觉反应控制商数、听觉注意力商数和视觉注意力商数均显著低于对照组(P均<0.001),视觉反应控制商数也明显低于对照组(P<0.01)。两组间比较,血铅、锌、铁值及铅中毒率差异均无显著性(P>0.05)。ADHD组血铅、锌、铁值与IVA-CPT商数间做相关分析,差异无显著性(P>0.05)。【结论】IVA^CPT能够较有效地区分ADHD儿童与正常儿童持续注意水平,对ADHD的诊断有较高的参考价值。ADHD组儿童的血铅值、铅中毒率、血锌、铁水平不一定是导致ADHD儿童注意损害的根本原因。

[Objective] To testify the objective significance and clinical value of integrated visual and auditory continuous performance test( IVA-CPT) on diagnosis of attention deficit-hyperactivity disorder (ADHD) and to explore the relationship of lead exposure and trace mineral elements with attention impairment of children. [ Methods] A total of 40 ADHD children were diagnosed with DSM-Ⅳ and 33 normal controls were tested with the software of IVACPT. All subjects were voluntarily examined blood lead level with anodic stripping voltammetry (ASV) and blood zinc/iron level with atomic absorb assay (AAA)also. All the data were analyzed and compared with SPSS 11. 0. [Results] Each variables of IVA-CPT in ADHD group was significantly lower than that in normal controls (P<0. 001 or 0. 01). The sensitivity of diagnosis was 87. 5% and the speciality was 87. 88%. No significant difference of blood lead/ zinc/ iron level was found between two groups (P>0. 05). The rate of lead poisoning in ADHD group was found no difference statistically too, in comparison with that in normal controls (P>0. 05). In ADHD group ,all blood mineral levels were not correlated significantly with the any quotient of IVA-CPT. [Conclusions] With the software of IVACPT, the ADHD children can be distinguished effectively from normal children by testing their sustained attention. Being an objective method on diagnosing ADHD, IVA-CPT has a higher value in clinical application. The blood levels of lead,zinc,iron in ADHD group were not different from those in normal controls, and these mineral concentration have no association with the variables of IVA-CPT. The changes of these trace elements are probably not the radical cause of ADHD in children.