哌甲酯控释片对注意力缺陷多动障碍患儿身高和体质量的影响

Influence of methylphenidate extended-Release tablets on height and weight in children with attention deficit hyperactivity disorder

目的观察哌甲酯控释片对注意力缺陷多动障碍(ADHD)患儿身高和体质量的影响,旨在为哌甲酯的临床应用提供参考。方法回顾性分析2007-01—12郑州市儿童医院收治的资料完整的94例ADHD患儿病例资料,男65例(69.1%),女29例(30.9%);混合型80例(85.1%),注意缺陷为主型14例(14.9%)。记录每例患儿性别、年龄、临床亚型、哌甲酯控释片剂量。测量诊断时和随访6、12、18、24、30、36、42、48个月时身高和体质量。采用SPSS 17.0统计学软件进行处理。结果随着随访时间的延长,患儿哌甲酯剂量逐渐增加,体质量指数(BMI,z值)从随访6个月开始逐渐降低,直到随访36个月才逐渐恢复。体质量(z值)从开始治疗逐渐下降,至随访18个月达到最低点,此后逐步回升。身高(z值)也从开始治疗逐渐下降,至随访30个月达到最低点,此后逐步回升。从绝对值来看,随着随访时间得延长患儿平均体质量和身高逐渐增加。诊断时患儿平均体质量低于预期体质量0.697kg,随访30个月时与预期体质量差距扩大到4.274kg,此后差距逐渐缩小,直到随访48个月时差距缩小到1.588kg。诊断时患儿平均身高低于预期身高0.42cm,随访30个月时与预期身高差距扩大到2.69cm,此后差距逐渐缩小,直到随访48个月时差距缩小到0.83cm。结论短期观察证实哌甲酯对ADHD患儿体质量和身高存在负面影响,长期临床观察发现ADHD患儿存在增长反弹趋势,哌甲酯对ADHD患儿生长曲线的影响可能随时间推移呈逐步衰减过程。

Objective To observe the influence of methylphenidate extended-release tablets（OROS-MPH） on height and weight in children with attention deficit hyperactivity disorder（ADHD）, in order to reference methylphenidate＇s clinical application. Methods Ninety four cases of ADHD with complete data in Children＇s Hospital of Zhengzhou from January to December in 2007 were analyzed retrospectively, in which 65（69.1%） were boys, 29（30.9%） were girls, 80（85.1%） were of ADHD-combined type and 14（14.9%） were of ADHD-predominantly inattention type. Height and weight were tested during diagnosis and the follow-up of 6, 12, 18, 24, 30, 36, 42 and 48 months. SPSS 17.0 software was chosen for the statistical a nalysis. Results With the extension of the follow-up, the methylphenidate dose increased gradually, body mass index （BMI, score） began to decrease from the 6th month and recovered until the 36th month. Both weight（z-score） and height（z-score） were decreased from the beginning of therapy, arrived at the lowest in the 18th month the 30th month, respectively, then in creased later gradually. In the absolute value, the children＇s average weight and height were increased along with the extension of follow-up time. The children＇s average weight was 0. 697 kg, which was lower than expected, after 30 months the gap was reached to 4. 274 kg, then decreased gradually to 1. 588 kg in the 48th month. The average height was 0.42 cm, which was lower than expected, after 30 months the gap was reached to 2.69 cm, then decreased gradually to 0.83 cm in the 48th month. Conclusion In short-term observation, it was proved that the methylphenidate had negative effects on height and weight of children with ADHD, while in long-term clinical observation, it was found that the children with ADHD had a trend of growth rebound. The influence of methylphenidate on growth curve in children with ADHD may have a gradually decay process with time passing.