对立违抗性障碍儿童的临床特征及血清单胺类神经递质水平的研究

The clinical characters and serum levels of biogenic amine neurotransmitters in children with oppositional defiant disorder

目的探讨对立违抗性障碍(ODD)患儿的临床特征及血清单胺类神经递质水平的变化。方法对31例 ODD 儿童(研究组)和36名正常儿童(对照组)测评 Piers-Harris 儿童自我意识量表(PHCSS)、儿童焦虑性情绪障碍筛查表(SCRED)、儿童抑郁障碍自评量表(DSRSC)及儿童冲动量表(BIS),测量其血清5-羟色胺(5-HT)、多巴胺(DA)等生物胺神经递质的含量。结果(1)研究组PHCSS 中的合群性分[(7.36±1.81)分]、幸福与满足感分[(5.45±1.69)分]低于对照组[(8.56±2.50)分和(6.31±1.72)分;P=0.030,P=0.045]。(2)两组 SCRED 和 DSRSC 评分的差异无统计学意义(P>0.05)。研究组 BIS 的冲动总分[(51.81±9.97)分]、运动分[(8.77±4.11)分]高于对照组[(48.30±11.57)分和(5.19±2.46)分;P=0.020,P=0.000]。(3)研究组血清高香草酸水平[中位数(M)=59 nmol/L]、5-HT 水平(M=20 nmol/L)低于对照组(M=130 nmol/L 和168 nmol/L;P=0.024,P=0.033)。(4)血清5-HT 水平与冲动总分(r=-0.650)、注意因子分呈负相关(r=-0.688);血清 DA 水平与广泛焦虑因子呈正相关(r=0.591);血清5-羟吲哚乙酸水平与分离焦虑因子、社交恐怖因子均呈负相关(r=-0.593,r=-0.535);血清高香草酸水平与抑郁(r=-0.694)、冲动因子呈负相关(r=-0.608),均 P<0.05和 P<0.01。结论 ODD 儿童不合群,缺乏愉快感,冲动性高;其血清5-HT 水平降低,而血清儿茶酚胺水平变化不明显。

Objective To explore the clinical characters and serum levels of biogenic amine neurotransmitters in children with oppositional defiant disorder （ODD）. Methods Thirty-one ODD children and 36 healthy children were evaluated with the Piers-Harris Children＇s Self- concept Scale, Screen for Child Anxiety Related Emotional Disorders, Depression Self-Rating Scale for Children, and Barratt＇s Impulsivity Scale. The serum 5-hydroxytryptamine （ 5-HT ） , dopamine （ DA ） , homovanillicacid （ HVA ）, 5-hydroxyindole-3-a ceticacid（5-HIAA ）, noreplnephrine （ NE ）, adrenaline （E） were determined by highperformance liquid chromatography （ HPLC ）. Results （ 1 ） The ＂popular＂ and ＂happiness and satisfy＂ scores in ODD group were significantly lower than that in control group （ P = 0. 030, P = 0. 045 ）. （2） The total impulsivity scores and motor scores in ODD group were significantly higher than that in control group （P =0. 020, P =0. 000）. （3）The serum 5-HT and HVA levels in ODD group were significantly lower than that in control group （ P = 0. 024, P = 0. 033 ）. （4） Significant correlations were found between the serum 5- HT level and the total impulsivity scores （ r = - 0. 650, P 〈 0. 05 ）. Conclusions Children with ODD are inferior in gregariousness or happiness feeling with stronger impulsive behaviors. The serum 5-HT level may be lower in ODD children while the serum catecholamine level be in normal range.