平动汤联合盐酸哌甲酯及生物反馈疗法治疗儿童注意缺陷多动障碍临床研究

Clinical study of Pingdong Decoction(平动汤)Combined with Methylphenidate Hydrochloride and Biofeedback Therapy in Children with Attention Deficit Hyperactivity Disorder

目的:探讨平动汤联合盐酸哌甲酯及生物反馈疗法治疗儿童注意缺陷多动障碍(ADHD)的临床效果。方法:将80例ADHD患儿用随机数字表法分为观察组与对照组各40例。两组均给予盐酸哌甲酯控释片+生物反馈疗法治疗,观察组在此基础上联合平动汤内服,所有患儿均治疗8周。对比两组临床疗效,治疗前后斯诺佩评估量表(SNAP-Ⅳ)-父母版评分、康纳父母评定量表评分、下丘脑-垂体-肾上腺轴(HPA)相关指标[血清皮质醇(COR)、促肾上腺皮质激素(ACTH)]水平、T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)水平及辅助性T细胞(Th1/Th2)相关细胞因子[γ干扰素(IFN-γ)、白细胞介素-4(IL-4)]水平变化,并观察不良反应发生情况。结果:观察组总有效率为97.50%,优于对照组的80.00%(P<0.05);两组治疗后SNAP-Ⅳ、康纳父母评定量表评分均较治疗前降低(P<0.05),且观察组减少更显著(P<0.05);两组治疗后血清COR浓度和外周血CD3+、CD4+水平及CD4+/CD8+均较治疗前升高(P<0.05),且观察组增加更显著(P<0.05),但两组治疗前后血清ACTH浓度及外周血CD8+水平比较差异均无统计学意义(P> 0.05);两组治疗后血清IFN-γ水平均较治疗前下降(P<0.05),血清IL-4浓度上升(P<0.05),且观察组表现优于对照组(P<0.05)。观察组不良反应发生率为10.00%,对照组15.00%,差异无统计学意义(P> 0.05)。结论:平动汤联合盐酸哌甲酯及生物反馈疗法治疗儿童ADHD,能正性调控患儿外周血T淋巴细胞亚群、血清中Th1/Th2相关细胞因子的表达水平及HPA功能,有效缓解患儿临床症状,且安全性较高。

Objective:To explore clinical effect of Pingdong Decoction(平动汤) combined with methylphenidate hydrochloride and biofeedback therapy on children with attention deficit hyperactivity disorder(ADHD). Methods:Eighty children with ADHD were divided into observation group and control group,using simple random number table method,40 cases in each group. Both groups were treated with methylphenidate hydrochloride controlled release tablets and biofeedback therapy. Observation group was also given Pingdong Decoction. The treatment lasted for 8 weeks. Clinical efficacy,scores of Swanson Nolan and Pelham(SNAP-IV)-parent from,and scores of Connor parent rating scale( CPRS), levels of hypothalamic-pituitary-adrenal( HPA) axis related indicators[cortisol(COR),adrenocorticotropic hormone(ACTH)],levels of T lymphocyte subsets(CD3+,CD4+,CD8+,CD4+/CD8+) and helper T cell Th1/Th2 related cytokines [γ-interferon(IFN-γ) and interleukin(IL-4)],and incidence of adverse reaction were observed and compared. Results:In observation group,clinical efficacy was 97.50%,and was higher than that in control group(80.00%)(P<0.05). After treatment,scores of SNAP-Ⅳ-parent form and CPRS were significant lower than those before treatment(P<0.05),and in observation group scores decreased more significantly(P<0.05). In both groups,levels of serum COR and peripheral blood CD3+and CD4+,and CD4+/CD8+ratio after treatment were significant higher than those before treatment(P<0.05),and in observation group increased more significantly(P<0.05). However,there was no significant difference in levels of serum ACTH and peripheral blood CD8+in both groups before and after treatment(P> 0.05). In both groups levels of serum IFN-γ after treatment decreased(P<0.05) and levels of serum IL-4 increased compared with before treatment(P<0.05),and in observation group,such changes were more obvious than the control group(P<0.05). The incidence of adverse reaction in the observation group was10.00% and in the control group was 15.00%. There was no statistical significance between both groups.Conclusion:Pingdong Decoction combined with methylphenidate hydrochloride and biofeedback therapy could positively regulate peripheral blood T lymphocyte subsets,serum Th1/Th2 related cytokine expression levels,and HPA axis function to relieve the clinical symptoms in children with ADHD effectively and with high safety.