注意缺陷多动障碍儿童的营养代谢水平及其与脑功能的相关性

Nutrition and metabolism level of children with attention deficit hyperactivity disorder and its correlation with brain function

目的评估注意缺陷多动障碍(ADHD)儿童的营养素水平及体脂代谢情况,分析营养代谢水平与大脑皮质功能的相关性,为ADHD的临床诊疗提供参考依据。方法选取2020年1-12月就诊于上海市儿童医院儿童保健科,初诊确诊为ADHD的患儿,招募同期体检的正常儿童,由家长提供人口学资料,临床医师对所有研究对象进行访谈评估。借助人体成份分析仪及脑功能定量成像装置分别检测体脂及脑功能,对所有研究对象行静脉血检测以获取维生素、微量元素、25(OH)D等营养素水平。结果选取筛选后的有效样本共60名,其中ADHD组和对照组各30名,维生素B12水平分别为(375.45±69.25)pm/ml、(421.68±103.72)pm/ml,差异有统计学意义(t=2.031,P<0.05)。与正常儿童相比,ADHD儿童的体重指数(BMI)及体脂率明显增加(t=2.026、2.106,P<0.05)。ADHD的脑皮质功能受损以右前额叶背外侧区域最为显著,25(OH)D、维生素E水平与大脑皮质激活程度相关(r=0.695、-0.571,P<0.05)。结论 ADHD儿童存在更高的肥胖风险,25(OH)D与大脑皮质激活程度呈正相关,可为临床辅助诊疗提供参考。

Objective To assess nutrient level and body fat metabolism of children with attention deficit hyperactivity disorder(ADHD), and to analyze the correlation between nutrient metabolism and cerebral cortex function, thus to provide reference for clinical diagnosis and treatment of ADHD. Methods Children diagnosed with ADHD in the Department of Child Health Care in Shanghai Children′s Hospital were enrolled in this study from January to December 2020. Children who had regular physical examinations during the same period were recruited. Demographic data were collected from parents, then clinicians conducted interviews and assessments with children using body composition analyzers and brain function quantitative imaging devices to test body fat metabolism and brain function indicators. Venous blood tests were performed on all participants to obtain vitamins, trace elements, 25-hydroxyl vitamin D [25(OH)D] and other nutrients levels. Results Totally 60 effective samples were selected after screening, including 30 children in ADHD group and 30 children in control group. Vitamin B12 levels of children in ADHD group and control group were(375.45±69.25) pm/ml and(421.68±103.72) pm/ml, respectively, and the difference was significant(t=2.031,P<0.05).Compared with children in control group, the body mass index(BMI) and body fat rate of ADHD children increased significantly(t=2.026, 2.106, P<0.05). The impairment of cerebral cortex function of ADHD was most prominent in the dorsolateral right prefrontal lobe. The levels of 25(OH)D and vitamin E were related to the degree of cerebral cortex activation(r=0.695,-0.571, P<0.05). Conclusions ADHD children have a higher risk of obesity. 25(OH)D is positively correlated with the degree of cerebral cortex activation, which may provide reference for auxiliary treatment of ADHD.