哌甲酯对学龄期注意缺陷多动障碍患儿生长发育影响的评价

Influence of methylphenidate on growth of school age children with attention deficit hyperactivity disorder

目的探讨长期服用哌甲酯对广州地区青春期前注意缺陷多动障碍(ADHD)患儿身高、体重增长的影响.方法以146例ADHD患儿为用药组,其中男126例,女20例,在连续服用哌甲酯0.27～0.64 mg/kg的过程中追踪2～4年余.另观察29例能坚持不服用哌甲酯的ADHD患儿作为对照组,其中男23例,女6例,同样随访2～4年.以1995年全国学生体质调查数据为正常生长指标对照,记录其身高、体重的变化,并分析相关影响因素.结果用药组治疗前、后身高与同龄均值绝对差距(简称身高绝对差距)的变化值为(-1.86±0.82) cm(P<0.001);治疗前、后身高标准差评分(SDS)变化为-0.14±0.23(P<0.001).对照组身高绝对差距变化值为(-0.26±0.51)cm,身高SDS变化值为+0.05±0.10.经Pearson 相关分析和多元逐步回归分析均提示疗程是治疗前、后身高绝对差距变化值的最主要影响因素(P<0.001).第1～4年的平均生长速度,第1年下降,第2年起回升(分别为4.28 cm/年、4.90 cm/年、4.98 cm/年和4.95 cm/年,P<0.001).治疗前、后体重与身高别体重绝对差距(简称体重绝对差距)的变化值为(-0.14±1.25)kg(P>0.05).结论长期服用哌甲酯对ADHD患儿生长发育的抑制作用,表现为身高增长的减慢.而且疗程越长,身高增长减慢越明显.其中身高增长减速以第1年最显著.对体重无显著影响.

Objective To determine whether long-term treatment of attention deficit hyperactivity disorder （ADHD）with methylphenidate influences the growth in height and weight of children. Methods Analyses were performed on 146 school age children （126 boys） diagnosed as ADHD and treated with methylphenidate [0. 27-0. 64 mg/（kg ·day）] for methylphenidate group and 29 children with ADHD who did not receive any medication for ADHD （controls）. These children were followed-up for 2-4 years. Changes in height and weight after long-term treatment with methylphenidate were recorded and the factors affecting growth of height, weight, and height velocity were analyzed. Results The change of difference between patients＇height and mean height in methylphenidate group and controls was （ - 1.86 ± 0. 82） cm （ paired t test, t = 27. 335, P 〈 0. 001 ） and （ - 0. 26 ± 0. 51 ） cm （ P 〈 0. 05 ） , respectively ; the change of height standard deviation score （SDS） in methylphenidate group and controls was -0. 14 ± 0. 23 SD（ paired t test, t = 7. 326, P 〈 0. 001 ） and ＋ 0. 05 ± 0. 10 SD（ P 〈 0. 05 ）, respectively. When the height change and height SDS change in methylphenidate group and controls were compared by using independent-samples Ttest, the t value was - 10. 078 and - 4. 262 respectively, P for both was 〈 0. 001. Both of bivariate correlation analysis and stepwise multiple-regression analysis indicated that the duration of treatment contributed significantly to the variance in change of height（P 〈0. 001 ） ; but age, sex, DSM-IV type,NJ22 degree and dose of methylphenidate did not contribute significantly to the variance of height. The mean height velocity from 1st to 4th year was 4. 28 cm/year, 4.90 cm/year, 4.98 cm/year and 4. 95 cm/year, respectively. With Friedman test, Chi-square = 253. 673, P 〈 0. 001. The change of difference of patients weight to weight for height after methylphenidate was （ -0. 14 ± 1.25） kg（paired t test, t = 1. 326, P 〉 0. 05 ）. Conclusion Small but significant deceleration of height velocity is the identified long-term side effect of methylphenidate, the magnitude of height deficit is related to duration of treatment. The height velocity was significantly attenuated in the first year. Methylphenidate had no significant influence on weight.