儿童注意缺陷多动障碍及其共患病临床分析

Clinical analysis of attention deficit hyperactivity disorder and its comorbidity in children

目的分析儿童注意缺陷多动障碍(ADHD)的临床特点及其共患病发生情况。方法选择2017年4月至2018年4月于北京大学第一医院、新乡市中心医院就诊的初诊ADHD患儿为研究对象,分析ADHD患儿的临床特点,并统计ADHD共患抽动障碍、癫痫、孤独症谱系障碍情况。结果共入选2330例ADHD患儿,男1793例(76.95%),女537例(23.05%),年龄3~18(8.71±3.66)岁,其中3~6岁594例(25.49%),7~12岁1429例(61.33%),13~18岁307例(13.18%)。ADHD共患抽动障碍患儿469例(20.13%),男、女性ADHD患儿抽动障碍共患率分别为20.69%(371/1793)、18.25%(98/537),男、女性ADHD患儿抽动障碍共患率比较差异无统计学意义(χ^2=0.043,P>0.05)。ADHD共患癫痫患儿355例(15.24%),男、女性ADHD患儿癫痫共患率分别为13.50%(242/1793)、21.04%(113/537),女性ADHD患儿癫痫共患率高于男性(χ^2=7.016,P<0.05)。ADHD共患孤独症谱系障碍患儿83例(3.56%),男、女性ADHD患儿孤独症谱系障碍共患率分别为3.40%(61/1793)、4.10%(22/537),男、女性ADHD患儿孤独症谱系障碍共患率比较差异无统计学意义(χ^2=0.085,P>0.05)。2330例ADHD患儿中,1368例接受药物治疗,ADHD患儿接受药物治疗率为58.71%(1368/2330),男、女性ADHD患儿接受药物治疗率分别为54.55%(978/1793)、72.63%(390/537),女性ADHD患儿接受药物治疗率高于男性(χ^2=7.067,P<0.05);367例患儿接受ADHD训练治疗,ADHD患儿ADHD训练治疗率为15.75%(367/2330),男、女性ADHD患儿接受ADHD训练治疗率分别为16.62%(298/1793)、12.85%(69/537),男、女性ADHD患儿接受ADHD训练治疗率比较差异无统计学意义(χ^2=0.061,P>0.05)。结论男性儿童ADHD发病率较高,ADHD患儿存在一定的共患病发病率,在诊断与治疗时应注意ADHD共患病,给予个体化治疗,提高治疗效果;ADHD患儿治疗率较低,应提昌早期积极治疗,以改善患儿预后。

Objective To analyze the clinical characteristics and comorbidity of attention deficit hyperactivity disorder(ADHD)in children.Methods The children with ADHD who were first diagnosed in the First Hospital of Peking University and Xinxiang Central Hospital from April 2017 to April 2018 were selected as the research objects.The clinical characteristics of ADHD children were analyzed,and the status of ADHD with tic disorder,epilepsy and autism spectrum disorder were analyzed,and the prevalence of tic disorder,epilepsy and autism spectrum disorder were analyzed.The data of ADHD patients with tic disorder,epilepsy and autism spectrum disorder were investigated.Results A total of 2330 children with ADHD were enrolled,1793(76.95%)children were males,537(23.05%)children were females;and the ages ranged from 3 to 18(8.71±3.66)years old,including 594(25.49%)children of 13-18 years old,1429(61.33%)children of 7-12 years old,and 307(13.18%)children of 13-18 years old.There were 469(20.13%)ADHD children with tic disorder,the comorbidity rate of tic disorder in male and female ADHD children was 20.69%(371/1793)and 18.25%(98/537),respectively.There was no significant difference in the comorbidity rate of tic disorder between the male and female children with ADHD(χ^2=0.043,P>0.05).A total of 355(15.24%)children with ADHD had epilepsy,the comorbidity rate of epilepsy in male and female ADHD children was 13.50%(242/1793)and 21.04%(113/537),respectively.The comorbidity rate of epilepsy in the female children was higher than that in the male children(χ^2=7.016,P<0.05).There were 83(3.56%)ADHD children with autism spectrum disorder,the comorbidity rate of autism spectrum disorder in male and female ADHD children was 3.40%(61/1793)and 4.10%(22/537),respectively.There was no significant difference in the comorbidity rate of autism spectrum disorder between the male and female children with ADHD(χ^2=0.085,P>0.05).Among the 2330 children with ADHD,1368 received drug treatment,and the rate of drug treatment was 58.71%(1368/2330).The rate of drug treatment in male and female ADHD children was 54.55%(978/1793)and 72.63%(390/537),respectively.The rate of drug treatment in the female children was higher than that in the male children(χ^2=7.067,P<0.05).A total of 367 ADHD children received training therapy,the rate of training therapy was 15.75%(367/2330).The rate of training therapy in the male and female children was 16.62%(298/1793)and 12.85%(69/537),respectively.There was no significant difference in the rate of training therapy between the male and female children(χ^2=0.061,P>0.05).Conclusion The incidence of ADHD in male children is high.ADHD children have a certain incidence of comorbidity,the attention should be paid to ADHD comorbidity during diagnosis and treatment,and individualized treatment should be given to improve the treatment effect.The treatment rate of children with ADHD is low,so the early treatment should be carried out in order to improve the prognosis of children.