经颅超声评估注意缺陷多动障碍儿童黑质回声的应用研究

Application of transcranial sonography in the assessment of substantia nigra echo in children with attention deficit hyperactivity disorder

目的利用经颅超声(TCS)技术分析儿童注意缺陷多动障碍(ADHD)患儿的超声神经影像学特点,探讨TCS对辅助诊断儿童ADHD的临床应用价值。方法前瞻性纳入2021年8月至2022年8月于苏州市立医院和苏州大学附属儿童医院就诊的50例6~12岁ADHD儿童(ADHD组)和年龄匹配的45例健康儿童(对照组),ADHD的诊断以美国精神病学会《精神疾病诊断与统计手册》第5版(DSM-Ⅴ)为标准,并根据患儿临床症状特征将其分为3种亚型,其中注意缺陷为主型14例,多动冲动为主型3例,混合型33例。应用TCS观察两组儿童中脑黑质(SN)的变化,测量SN强回声面积并计算SN强回声面积与中脑面积的比值(S/M),比较两组间各参数的差异。采用Pearson相关分析法分析ADHD组SN强回声面积和S/M与DSM-Ⅴ评分的相关性。结果半定量分析:ADHD组SN强回声≥Ⅲ级比例明显大于对照组[96.00%(48/50)比13.33%(6/45),P<0.05]。定量分析:ADHD组SN强回声面积、S/M大于对照组[0.32(0.22,0.38)cm^(2)比0.00(0.00,0.00)cm^(2),7.08(5.11,8.75)%比0.00(0.00,0.00)%,均P<0.05]。相关性分析:ADHD组SN强回声面积和S/M与DSM-Ⅴ评分之间无明显相关性(r=0.144、0.142,均P>0.05)。结论TCS可以发现ADHD患儿SN回声增强,SN回声增强比例、SN强回声面积及S/M明显高于正常儿童,但SN强回声面积和S/M与DSM-Ⅴ评分无明显相关性。

Objective To determine the clinical application value of transcranial sonography(TCS)in the diagnosis of attention deficit hyperactivity disorder(ADHD)in children.Methods A total of 50 children aged 6-12 years diagnosed with ADHD(ADHD group)and 45 age-matched healthy children(control group)who presented to Suzhou Municipal Hospital and Children′s Hospital of Soochow University from August 2021 to August 2022 were prospectively enrolled for TCS examination.ADHD was diagnosed in accordance with the Diagnostic and Statistical Manual of Mental Disorders,fifth edition(DSM-Ⅴ)criteria established by the American Psychiatric Association.Based on clinical symptom characteristics,ADHD was further classified into 3 subtypes,including 14 cases of predominantly inattentive,3 cases of predominantly hyperactive/impulsive,and 33 cases of combined presentation.The substantia nigra(SN)hyperechoic area and the ratio of SN hyperechoic area to midbrain area(S/M)were measured and compared between the two groups.The examination of the correlation was performed between SN hyperechoic area,S/M ratio,and DSM-Ⅴscores within the ADHD group.Results Semi-quantitative analysis:the proportion of the SN gradeⅢor more in ADHD group was significantly higher than that in control group[96.00%(48/50)vs 13.3%(6/45),P<0.05].Quantitative analysis:the area of SN hyperechogenicity and the ratio of S/M were significantly larger in ADHD group than in control group[0.32(0.22,0.38)cm^(2)vs 0.00(0.00,0.00)cm^(2),7.08(5.11,8.75)%vs 0.00(0.00,0.00)%,all P<0.05].Correlation analysis:The SN hyperechoic area and S/M ratio showed no significant correlations with DSM-Ⅴscores in the ADHD group(r=0.144,0.142,all P>0.05).Conclusions TCS can detect the SN echo enhancement of ADHD children,and the proportion of SN echo enhancement,SN hyperechoic area and S/M ratio are significantly higher than those of normal children,but the SN hyperecho area and S/M ratio are not significantly correlated with DSM-Ⅴscores.