哌甲酯控释剂对注意缺陷多动障碍患儿生态学执行功能的影响

Effect of extended-release methylphenidate on the ecological executive function for attention deficit hyperactivity disorder

目的:研究哌甲酯控释剂治疗对注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患者生态学执行功能的影响,探讨执行功能改善和临床症状改善两者之间的关系。方法:对符合美国《精神障碍诊断与统计手册(第4版)》(DSM-Ⅳ)诊断标准的26名8～14岁的ADHD患者使用哌甲酯控释剂(18～54 mg/d)治疗4～6周,以父母填写的简明Conners儿童行为问卷及ADHD-Ⅳ父母问卷为主要疗效评价指标,以家长填写的执行功能行为评定量表(BRIEF)评价患者生态学执行功能的情况。结果:经哌甲酯控释剂治疗后,BRIEF执行总分,元认知指数及其所属的工作记忆和监控因子、抑制因子条目的原始平均分比治疗前显著下降(t=2.763～3.380,P<0.05);BRIEF抑制因子减分率与症状最大减分率的相关性差异无统计学意义,BRIEF元认知指数及其所属5个因子的减分率与ADHD-Ⅳ父母问卷中注意缺陷因子的最大减分率呈中度相关(r=0.415～0.640,P<0.05)。结论:哌甲酯控释剂有望改善ADHD患者的生态学执行功能水平;ADHD患者抑制缺陷的改善与核心症状的改善可能不平行。

Objective： To test the effect of extended-released methylphenidate （Concerta） on ecological executive function for attention deficit hyperactivity disorder （ADHD） and to evaluate the correlation between the improvement of ecological executive function and that of the core symptom of ADHD. Methods： We conducted a 4 -6-week open-trial study of extended-released methylphenidate （18 -54 mg/d） in 26 children with ADHD, aged 8 - 14 years. Ecological executive function and ADHD symptoms were ascertained by the parent form of behavior rating inventory of executive function （ BRIEF）, ADHD-Ⅳ rating scale and Conners short form rating scales before and after the treatment. Results： The mean item raw score of global executive composite （ GEC ）, metaeognition index （ MI）, working memory, monitor and inhibition subseale of BRIEF were significantly decreased after the treatment （t = 2. 763 - 3. 380, P 〈 0.05 ）. The reduction rates of MI and the 5 subseales attached to MI were moderately correlated to the maximum reduction rates of the inattentive subseale of ADHD-Ⅳ rating scale （r = 0.415 -0.640, P 〈 0.05）. While the correlation between the reduction rate of inhibition subseale and the maximum reduction rates of ADHD symptom were not significant. Conclusion： The extended-released methylphenidate was proved to have the potential to improve ecological executive function of ADHD. The improvement of inhibition might not parallel that of the core symptom of ADHD.