盐酸托莫西汀胶囊联合维生素D滴剂治疗儿童注意缺陷多动障碍的临床效果及对血清25-羟维生素D水平的影响

Clinical effect of tomoxetine hydrochloride capsule combined with vitamin D drop in treatment of attention deficit hyperactivity disorder and the impact on serum 25-hydroxyvitamin level

目的分析盐酸托莫西汀胶囊联合维生素D滴剂治疗儿童注意缺陷多动障碍(ADHD)的临床效果及对血清25-羟维生素D水平的影响。方法选取2019年1月—2022年12月在荆州市妇幼保健院门诊就诊的161例ADHD患儿,将患儿随机分为3组,联合组55例给予托莫西汀胶囊联合维生素D滴剂治疗,托莫西汀组51例单用盐酸托莫西汀胶囊治疗,维生素D组55例单用维生素D滴剂治疗。3组均连续治疗12周,分别在治疗前后检测25-羟维生素D水平,使用SNAP-Ⅳ量表评估患儿的临床症状。结果联合组治疗前25-羟维生素D水平为(18.79±4.23)ng/ml,治疗后25-羟维生素D水平为(38.14±4.23)ng/ml;托莫西汀组治疗前25-羟维生素D水平为(19.11±4.92)ng/ml,治疗后25-羟维生素D水平为(23.43±4.20)ng/ml;维生素D组治疗前25-羟维生素D水平为(18.46±4.52)ng/ml,治疗后25-羟维生素D水平为(37.35±3.36)ng/ml。治疗前,3组患儿血清25-羟维生素D水平比较差异无统计学意义(P>0.05)。治疗后12周,维生素D组、联合组患儿血清25-羟维生素D水平均显著升高,差异均有统计学意义(均P<0.05)。治疗后4周和12周,3组患儿SNAP-Ⅳ量表评分均较治疗前降低,差异均有统计学意义(均P<0.05)。治疗后4周和12周,3组患儿SNAP-Ⅳ量表评分比较差异均有统计学意义(均P<0.05)。治疗后12周,联合组总有效率为88.68%,托莫西汀组总有效率为86.00%,维生素D组总有效率为47.27%,3组临床总有效率比较差异有统计学意义(χ^(2)=28.732,P<0.05)。托莫西汀组患儿不良反应总发生率为14.00%,联合组患儿不良反应总发生率为16.98%,维生素D组未见不良反应。结论单用维生素D滴剂治疗ADHD有一定的临床疗效,盐酸托莫西汀胶囊联合维生素D滴剂治疗儿童ADHD的临床疗效更好。

Objective To analyze the clinical effect of tomoxetine hydrochloride capsule combined with vitamin D drop in treatment of attention deficit hyperactivity disorder(ADHD)and the impact on serum 25-hydroxyvitamin level.Methods A total of 161 children with ADHD in Jingzhou Maternity and Childcare Hospital from January 2019 to December 2022 were selected as research object.The children were randomly divided into three groups:55 cases in combined group(tomoxetine capsule combined with vitamin D drop),51 cases in tomoxetine group(tomoxetine hydrochloride capsule),and 55 cases in vitamin D drop group(vitamin D drop).All the children in the three groups were treated continuously for 12 weeks.The clinical symptoms were scored by SNAP-Ⅳscale,the levels of 25-hydroxyvitamin D in the three groups before and after treatment were detected.Results In combined group,the levels of 25-hydroxyvitamin D before and after treatment were(18.79±4.23)ng/ml and(38.14±4.23)ng/ml,respectively;in tomoxetine group,the levels of 25-hydroxyvitamin D before and after treatment were(19.11±4.92)ng/ml and(23.43±4.20)ng/ml,respectively;in vitamin D group,the levels of 25-hydroxyvitamin D before and after treatment were(18.46±4.52)ng/ml and(37.35±3.36)ng/ml,respectively.Before treatment,there was no statistically significant difference in serum 25-hydroxyvitamin D level among the three groups(P>0.05).At 12 weeks after treatment,the levels of 25-hydroxyvitamin D in vitamin D group and combined group increased significantly(P<0.05).At 4 and 12 weeks after treatment,the scores of SNAP-Ⅳscale in the three groups decreased significantly compared with before treatment(P<0.05).At 4 and 12 weeks after treatment,there were statistically significant differences in the score of SNAP-Ⅳscale among the three groups(P<0.05).At 12 weeks after treatment,the total effective rates in combined group,tomoxetine group,and vitamin D group were 88.68%,86.00%,and 47.27%,respectively,there was statistically significant difference among the three groups(χ^(2)=28.732,P<0.05).The total incidence rates of adverse reactions in tomoxetine group and combined group were 14.00%and 16.98%,respectively,no adverse reaction was found in vitamin D group.Conclusion Vitamin D drop has a certain clinical effect in treatment of ADHD,while tomoxetine hydrochloride capsule combined with vitamin D drop is more effective.