哌甲酯控释剂对注意缺陷多动障碍儿童抑制功能的影响

Effects of Extended-released Methylphenidate on the Inhibition of Children with Attention Deficit Hyperactivity Disorder

目的:探讨哌甲酯控释剂对注意缺陷多动障碍(Attention Deficit/Hyperactivity Disorder,ADHD)儿童临床症状、不同维度(操作性神经心理测查和生态学)抑制功能的影响以及临床症状改善与不同维度抑制功能改善之间的关系。方法:采用自身对照研究,对符合DSM-IV诊断标准的28名ADHD患者[年龄(10.8±1.8)岁],使用哌甲酯控释剂(18～54mg/d)治疗4～6周,以ADHD症状评定问卷(父母问卷)为主要临床疗效评价指标,以自编的计算机版本的Go/No Go任务评定ADHD患者操作性神经心理测查的抑制功能,以执行功能行为评定量表(BRIEF)中的抑制因子得分评价ADHD患者生态学抑制功能的情况。结果:经哌甲酯控释剂治疗后,ADHD患者临床症状的总分[(32.8±9.2)vs.(20.7±11.9)],注意缺陷[(18.6±4.1)vs.(11.5±6.1)]及多动冲动评分[(14.2±6.6)vs.(9.1±6.6)]、Go/No Go任务虚报数[(22.0±10.9)vs.(14.8±10.4)],以及BRIEF量表中抑制因子的得分[(2.0±0.5)vs.(1.7±0.4)]较服药前均显著下降(P<0.05);相关性分析发现,ADHD注意缺陷分的改善率与Go/No Go任务虚报数的改善率呈正相关(r=0.42,P<0.05),多动冲动症状的改善率与BRIEF量表中抑制因子的改善率呈正相关(r=0.50,P<0.01)。结论:哌甲酯控释剂能有效地改善ADHD患者的临床症状及不同维度的抑制功能。BRIEF量表中抑制因子得分的改善与ADHD多动冲动症状的改善相关,操作性神经心理测查的执行功能测定是对临床实践的必要补充。

Objective： To examine the effects of extended-released methylphenidate （Concerta） on clinical improvements and different dimensions （ experimental psychological and ecological ） inhibition of children with attention deficit hyperactivity disorder （ ADHD ）, and to evaluate the correlation between the improvement of ADHD symptoms and that of different dimensions inhibition. Methods： In this self-control study, 28 children with ADHD [ aged （ 10. 8 ± 1.8） years] were treated with extended-released methylphenidate （18 -54mg/d） for 4 -6 weeks. ADHD symp- toms, including experimental psychological inhibition and ecological inhibition, were assessed with the parent form ADHD -IV rating scale, Go/No Go task and inhibition subscale of BRIEF before and after the treatment respectively. Results： The scores of the parent form ADHD -IV rating scale [ （32. 8 ±9. 2） vs. （20. 7±11.9） ], inattentive subscale [ （ 18.6 ±4. 1 ） vs. （ 11.5 ±6. 1 ） ], hyperactive/impulsive subscale [ （ 14. 2±6. 6） vs. （9. 1 ±6. 6） ], inhibition subscale of BRIEF [ （ 1.96 ± 0. 52 ） vs. （ 1.73 ± 0. 431 ] and the commission numbers of Go/No go task [ （ 22. 0± 10. 9） vs. （ 14. 8±10. 4 ） ] were significantly decreased after the treatment with extended-released methylphenidate （ Ps 〈 0. 05 ） . The reduction rate of the inattentive subscales had positive correlation with that of the commission numbers in the Go/No go task （r = 0. 415, P 〈 0. 05 ）, and the reduction rate of the hyperactive/impulsive subscales had positive correlation with that of the inhibition subscale of BRIEF （r = 0. 500, P 〈 0. 01 ） . Conclusion： The extended-released methylphenidate not only has significant clinical effects, but also can improve the experimental psychological and ecological inhibition for the children with ADHD. The BRIEF scale has good etiological validities for evaluating the executive functions for ADHD, and the experimental psychological tests are the necessary compensations for executive functions evaluation in clinical practices.