儿童注意缺陷多动障碍的脑磁共振氢谱研究

Brain 1H MRS study in children suffering from attention-deficit/hyperactivity disorder

目的 观察注意缺陷多动障碍患儿脑内可能存在的神经生化异常及哌甲酯对其的影响。方法 使用无创性的磁共振氢谱检查 ,测量了 12例患注意缺陷多动障碍儿童顿服哌甲酯 10mg前后双侧苍白球内天冬氨酸 (NAA)、胆碱复合物 (Cho)、肌醇 (mI)、α 氨基酸 (glutamateplusglutamine ,α Glx)与肌酸 (Cr)的比值 ,并与 12例同龄健康儿童的结果进行比较。结果 服药前注意缺陷多动障碍患儿双侧纹状体的NAA/Cr比值较健康儿童显著降低 (左侧t=7 0 1,P <0 0 1;右侧t=4 95 ,P <0 0 1) ;Cho/Cr比值有单侧显著性增高 (t=2 33,P <0 0 5 ) ;mI/Cr和α Glx/Cr比值无显著性变化。服药后NAA/Cr比值增高 ,但与服药前相比差异无显著性意义 (左侧t =- 1 34,P >0 0 5 ;右侧t =- 1 0 4 ,P >0 0 5 ) ,与健康儿童间差异仍有显著性意义 (左侧t=3 6 8,P <0 0 1;右侧t=2 5 0 ,P <0 0 5 ) ;Cho/Cr比值降至正常水平 ,与健康儿童间差异不再有显著性意义 (t=0 87,P >0 0 5 )。结论注意缺陷多动障碍患儿双侧纹状体存在神经元缺失或功能障碍 。

Objective To determine whether the children suffering from Attention deficit/hyperactivity disorder (ADHD) had neurochemical abnormalities in basis ganglia and if the state could be affected by methylphenidate. Methods Proton magnetic resonance spectroscopy scans were performed on bilateral globus pallidus of 12 ADHD boys before and after one dose of methylphenidate 10 mg. Spectral peaks of N acetylaspartate (NAA), choline (Cho), myo inositol (mI),glutamate plus glutamine(α Glx) and creatine (Cr) were measured and their ratios were compared with 12 age , handedness , and IQ matched healthy boys. Results In children having ADHD, NAA/Cr ratio decrease significantly in bilateral globus pallidus (left side t =7.01, P <0.01; right side t =4.95, P <0.01), while only the right globus pallidus shows significant Cho/Cr ratio rise ( t =2 33, P <0.05,). The abnormalities could be improved by one dose of methylphenidate. However, the post drug NAA/Cr ratios were not significantly different from the pre drug ratios (left side t =-1.34, P >0.05;right side t = -1.04, P >0.05). The post drug NAA/Cr ratios in ADHD children remained significantly different from those in healthy children (left side t =3.68, P <0.01;right side t =2.50, P <0.05) The post drug Cho/Cr ratio was no more significantly differ from controls ( t =0.87, P >0.05) Conclusion In children suffering from ADHD, neuronal loss/dysfunction exists in bilateral striatum. One does of methylphenidate could not affect the state significantly. Further investigations are needed to confirm whether the cholinergic system is involved in ADHD.