BECT患儿共患ADHD的锌、钙水平变化及发病相关因素分析

Analysis of the changes of zinc and calcium levels and factors associated with the development of ADHD in children with BECT

目的 分析儿童良性癫痫伴中央颞区棘波(BECT)患儿共患注意缺陷多动障碍(ADHD)的发病的相关危险因素,同时观察锌、钙、25-羟维生素D元素水平的变化,为控制癫痫发作和多动症抽动、改善预后、提高共患疾病治疗的依从性提供理论依据。方法 将2020年1月~2021年10月在潍坊医学院附属医院及日照市人民医院就诊的140例患儿作为研究对象,分为单纯BECT(118例)组及共患ADHD组(22例),对照组为同一时间于儿童保健门诊接受健康查体的40例儿童,检测并分析3组儿童体内锌、钙、25-羟维生素D水平在发病中的变化。采用自行设计的调查问卷,收集患儿年龄、性别、治疗药物、家族史、脑电图结果等资料,并进行相关危险因素Logistic回归分析。结果 单纯BECT组及共患ADHD组患儿血清锌、钙以及25-羟维生素D浓度均明显低于对照组儿童(P<0.05),但单纯BECT组与共患ADHD组两组患儿体内锌、钙以及25-羟维生素D浓度变化无统计学意义(P>0.05)。采用单因素分析,结果提示多种抗癫痫药物治疗、双侧Rolandic区放电、不容易控制BECT发作、延迟诊治方面均有统计学意义(P<0.05)。通过Logisitc回归分析,不容易控制BECT发作、双侧Rolandic区放电与共患ADHD有关(均P<0.05)。结论 单纯BECT及共患ADHD患儿血清锌、钙、25-羟维生素D水平较对照组低;BECT患儿共患ADHD的危险因素依次是不容易控制BECT发作、双侧Rolandic区放电,BECT共患ADHD,早期抗癫痫药物联合可乐定对共患患儿临床症状控制效果较好。

Objective To analyze the risk factors related to the onset of co-morbid attention deficit hyperactivity disorder(ADHD) in children with benign epilepsy with central temporal spikes(BECT),and to observe the changes in the levels of zinc, calcium, and 25-hydroxyvitamin D,in order to provide a theoretical basis for clinical treatment by controlling seizures and ADHD tics, improving prognosis, and increasing compliance with treatment for co-morbidities.Methods A total of 140 children who were treated in the Affiliated Hospital of Weifang Medical University and People’s Hospital of Rizhao from January 2020 to October 2021 were divided into BECT-only(118 cases)group and co-morbid ADHD group(22 cases).The control group consisted of 40 children who received physical examination at the same time at the children’s health clinic.The changes of zinc, calcium, and 25-hydroxyvitamin D levels in the three groups of children during morbidity were detected and analyzed.A self-designed questionnaire was used to collect information on children’s age, gender, treatment medication, family history, EEG results, and logistic regression analysis of relevant risk factors was performed.Results Serum zinc, calcium and 25-hydroxyvitamin D concentrations were significantly lower in children in the BECT-only and ADHD co-morbidities groups than in control group(P<0.05).But the changes were not statistically significant between BECT-only and ADHD co-morbidities groups(P>0.05).The results were statistically significant in terms of multiple anti-epileptic drug treatments, bilateral Rolandic area discharges, not easily controlled BECT seizures, and delay in diagnosis and treatment by using univariate analysis(P<0.05).Not easily controlled BECT seizures and the discharge of bilateral Rolandic areas is related to co-morbid ADHD through Logisitc regression analysis(all P<0.05).Conclusion The levels of serum zinc, calcium, and 25-hydroxyvitamin D in children with BECT alone and co-morbid ADHD were lower than those in the control group;Risk factors for co-morbid ADHD in BECT children were, in turn, difficulty in controlling BECT onset, bilateral Rolandic discharges.AEDs combined with clonidine has a better clinical symptoms control effect in co-morbid children.