盐酸哌甲酯控释剂治疗伴共患病儿童ADHD效果分析

Efficacy of methylphenidate hydrochloride controlled release agent on ADHD children with comorbidity

目的研究盐酸哌甲酯控释剂对伴有共患病儿童注意缺陷多动障碍(ADHD)的临床治疗效果。方法采取自身对照研究方法,将2014年6月至2016年5月在上海市儿童医院儿保门诊就诊且符合精神障碍诊断与统计手册第5版(DSM-Ⅴ)中ADHD评估标准,联合型瑞文测验(CRT)>85的680例患儿,分为无共患病组、单共患病组、双/三共患病组,给予盐酸哌甲酯控释剂治疗,分别于6周、6个月后采用斯诺佩评估量表(SNAP-Ⅳ)家长使用量表进行疗效评估,观察共患病对ADHD患儿治疗效果的影响。结果共患病对不同类型ADHD治疗效果均存在一定影响,多动/冲动型(ADHD-HI)中,无共患病组治疗有效率高于共患病组(χ2=4.841,P<0.05);注意缺陷型(ADHD-I)中,无共患病组的治疗有效率高于1项及以上共患病组(χ2值分别为7.405和10.136,均P<0.05);混合型中(ADHD-C),无共患病组和1项共患病组的有效率高于1项以上共患病组(χ2值分别为8.767和5.376,均P<0.05)。结论盐酸哌甲酯控释剂治疗儿童ADHD疗效受到共患病的影响。

Objective To study the clinical efficacy of methylphenidate hydrochloride controlled release agent on attention deficit hyperactivity disorder(ADHD)children with comorbidity.Methods Based on method of self-control,680 children,who visited Child Health Care Clinic of Shanghai Children’s Hospital and complied with ADHD standards in Diagnostic and Statistical Manual of Mental Disorders 5 th edition(DSM-V)and whose combined Raven test(CRT)was above 85 during the period of June 2014 to May 2016,were divided into pure ADHD group,single comorbidity ADHD group and two/three comorbidities ADHD group.Patients in three groups were treated with methylphenidate hydrochloride controlled release agent.Therapeutic efficacy was evaluated at 6 weeks and 6 months after treatment respectively with SNAP-IV for parents to observe the influence of comorbidities on treatment effect of ADHD in children.Results Comorbidities could influence treatment effect of all types of ADHD.For hyperactive impulsive type(ADHD-HI),methylphenidate hydrochloride controlled release agent was more effective in pure ADHD group than in comorbidity ADHD groups(χ2=4.841,P<0.05).For inattentive type(ADHD-I),more effectiveness was observed in pure ADHD group than in single comorbidity ADHD group and two/three comorbidities ADHD group(χ2 value was 7.405 and10.136,respectively,both P<0.05),and for combined type(ADHD-C),effective rate was higher in pure ADHD group and single comorbidity ADHD group than in two/three comorbidities ADHD group(χ2 value was 8.767 and 5.376,respectively,both P<0.05).Conclusion Comorbidities can influence therapeutic efficacy of methylphenidate hydrochloride controlled release agent on ADHD children.