哌甲酯治疗注意缺陷多动障碍疗效影响因素

The factors affecting efficacy of methylphenidate treatment for attention deficit hyperactivity disorder on

目的分析临床特征对哌甲酯治疗注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患儿疗效的影响。方法对110例ADHD汉族患儿给予哌甲酯速释剂型6周滴定治疗。以ADHD症状分级父母评量表(ADHD rating scale-IV home version,ADHD-RS-IV)为临床疗效指标,持续操作测验(continuous performance task,CPT)各单项T分为认知功能疗效指标,对可能影响疗效的人口学资料、基线临床特征和认知因素进行分析。结果临床疗效指标治疗有效65例(59.1%),无效45例(40.9%)。87例患儿接受CPT测验,错误数单项有效35例(40.2%),漏报数单项有效31例(35.6%),反应时间单项有效10例(11.5%)。logistic回归提示父母关系好(OR=3.516,95%CI:1.087~11.375)和基线ADHD-RS-IV量表分高于35分(OR=3.075,95%CI:1.131~8.359)是临床疗效指标治疗有效的预测因素(P<0.05)。智商分较高是认知功能指标CPT错误数T分(OR=1.085,95%CI:1.013~1.162)和漏报数T分(OR=1.078,95%CI:1.008~1.153)有效的预测因素(P<0.05)。结论治疗前临床症状严重和CPT测验结果差、父母关系好、智商较高的患者有可能哌甲酯治疗效果更好。

Objective To explore the factors affecting methylphenidate(MHP)efficacy in children with attention deficit hyperactivity disorder(ADHD).Methods One hunadard eleven DSM-IV defined ADHD patients were enrolled for 6 weeks systemic MHP titration treatmnet.ADHD Rating Scale-IV Home Version(ADHD-RS-IV)were applied as index of clinical efficacy,and Continuous Performance Task(CPT)as index of cognition efficacy.Determining potential influential factors was analyzed on MPH efficacy including demographic,baseline clinical symptoms and cognitive factors.Results Sixty-five(59.1%)were defined as responders and 45(40.9%)as non-reponders to MHP,respectively.CPT which were conducted in 87 patient showed that 35(40.2%)were defined as responders on commission errors,31(35.6%)on omission errors and 10(11.5%)on reaction time.Logistic analysis revealed two potential influential factors that predicted better clinical efficacy(P<0.05):better parental relationship(OR=3.516,95%CI:1.087~11.375)and baseline ADHD-RS-IV score above 35 points(OR=3.075,95%CI:1.131~8.359).Higher IQ score was the potential influential factor that predicted better commission errors efficacy(OR=1.085,95%CI:1.013~1.162)and omission errors efficacy(OR=1.078,95%CI:1.008~1.153).Conclusion MHP efficacy may result in better outcomes in children with ADHD who have higher baseline ADHD-RS-IV score,poorer baseline CPT result,younger onset age,higher IQ and better parental relationship.