伴与不伴对立违抗性障碍的注意缺陷多动障碍儿童脑α波竞争图比较

Alpha competitive structure in children with attention deficit hyperactivity disorder with/without oppositional defiant disorder

目的:探讨伴与不伴对立违抗性障碍(ODD)的注意缺陷多动障碍(ADHD)儿童脑α波竞争图特点及其神经生理机制。方法:以符合美国《精神障碍诊断与统计手册(第4版)》(DSMⅣ-)诊断标准,并按照性别、年龄及ADHD亚型配对的单纯ADHD、ADHD共患ODD及正常儿童各46例为研究对象,应用脑电超慢涨落分析仪,采集并分析处理三组儿童的脑电信号α波。结果:(1)单纯ADHD儿童8 Hz全脑平均优势几率(28.07%±15.57%)明显高于正常儿童(18.72%±11.42%),差异有统计学意义(P=0.004);ADHD共患ODD组8 Hz全脑平均优势几率(24.78%±13.31%)与单纯ADHD组及正常对照组比较差异均无统计学意义(P>0.05)。(2)ADHD共患ODD组在右额、右中央、双侧枕部的熵值明显高于正常对照组,差异均有统计学意义(P<0.05)。结论:单纯ADHD儿童脑发育迟缓,ADHD共患ODD儿童右脑有序度差,提示两组儿童可能具有不同的神经病理机制。

Objective： To explore the alpha competitive structure in children with attention deficit hyperactivity disorder （ADHD） with/without oppositional defiant disorder （ODD）. Methods ： According to DSM-Ⅳ diagnostic criteria, the study involved ADHD children with ODD, pure ADHD children and normal controls. Each group consisted of 46 subjects. All subjects were between the ages of 7 and 14 years, and the groups were matched by gender, age and ADHD subtypes. Electroencephalogram（EEG） data were recorded during an eye-closed resting period and then were analyzed with EEG - encephaloflutuographic technology （EEG-ET） . Results ： （ 1 ） The pure ADHD children showed significantly more 8 Hz activity （28.07% ±15.57% ） than that of the normal control group （ 18.72% ±1.42% , P = 0. 004）. Compared with ADHD children with ODD, children and normal controls in terms of the dominant there were no significant differences in pure ADHD probability of 8 Hz （P 〉 0.05 ）. （2） The entropy value of the ADHD with ODD group was significantly higher than that of the normal controls in the right frontal region, right central region, and bilateral occipital region （ P 〈 0.05 ）. Conclusion ： The pure ADHD children show more maturational lag pattern in the central neurous system than that of children with ADHD and comorbity ODD. However, children with ADHD and comorbity ODD have poor brain self-organizition ability in the right frontal lobe. The current results suggest that the pathogenic mechanisms may be different between ADHD comorbid with or without ODD.