注意缺陷多动障碍患儿哌甲酯治疗前后的脑诱发电位研究  

Comparative study of evoked potentials in children with attention deficit and hyperactivity disorder before and after methylphenidate treatment

作　　者：吴丽慧[1] 吴伟[1] 叶祎[1] 李建策[2] 王美豪[2] 留佩宁[1] 

机构地区：[1]温州医学院附属育英儿童医院儿童保健科,325003 [2]温州医学院附属一院放射科,325003

出　　处：《中华精神科杂志》2007年第1期32-35,共4页Chinese Journal of Psychiatry

基　　金：浙江省自然科学基金(M303002);浙江省科技厅对外合作资助项目(2004C34008)

摘　　要：目的探讨注意缺陷多动障碍(ADHD)患儿4种脑诱发电位指标及其治疗前后的特点。方法应用美国 Nicolet spirit 脑诱发电位仪,记录37例 ADHD 患儿(ADHD组)和30名正常儿童(正常对照组)的事件相关电位 P_(300)、失配性负波(MMN)、关联性负变(CNV)和脑干听觉反应(ABR),对其中31例 ADHD 患儿于哌甲酯(10～15 mg 口服)治疗4个月后再次检测。结果 (1)与正常对照组比较,ADHD 组 P_(300)-N_2靶潜伏期长,P_(300)-P_3靶波幅低;ABR-波Ⅲ绝对潜伏期短,绝对波幅波Ⅴ低;MMN 潜伏期长,波幅高;CNV-M_2波幅低,反应时间(RT)长;差异均有统计学意义(P<0.05～0.01)。(2)哌甲酯治疗4个月后,ADHD 组随多动症状改善,P_(300)-N_2靶潜伏期缩短[治疗前后分别为(278±18)ms 和(261±16)ms,P<0.01],P_3靶波幅升高[分别为(2.8±1.8)μV和(4.2±1.9)μV,P<0.05];MMN 潜伏期缩短[分别为(208±24)ms 和(193±24)ms,P<0.05];CNV-M_1波幅升高[分别为(10.3±5.0)μV和(14.3±4.1)μV,P<0.01];RT 缩短[分别为(478±158)ms 和(349±144)ms,P<0.01],但 ABR 治疗前后的差异无统计学意义(P>0.05)。结论 ADHD 患儿的 P_(300),MMN,CNV 和 ABR 4种脑电诱发电位较正常对照组均有改变;治疗后随多动症状的改善,与认知功能有关的 P_(300),MMN 和 CNV 3项指标亦有相应的改善。Objective To assess the characteristics of evoked potentials in children with attention deficit and hyperactivity disorder （ADHD） before and after treatment. Methods There were 37 ADHD children, 30 normal controls included into this study. Event-related potentials P300, mismatch negativity （MMN）, contingent negative variation （CNV）, and auditor brainstem response （ABR） were recorded from every subject. And 31 ADHD children were followed after 4 month methylphenidate treatment. Results Compared with controls, ADHD children showed significantly prolonged N2/P300 and MMN latencies, shortened Ⅲ/ABR latency, decreased P3/P300 and V/ABR amplitudes, increased MMN amplitude, and delayed reaction time （P 〈 0.05-0. 01 ）. After methylphenidate treatment, ADHD children had shortened N2/P300 latency [ （278 ± 18） ms vs. （261 ± 16） ms, P 〈 0.01 ], increased P3 amplitude [ （ 2. 8 ±1.8） μV vs. （4.2 ± 1.9） μV, P 〈 0.05 ], shortened MMN latency [ （208 ± 24） ms vs. （ 193 ± 24） ms, P 〈 0. 05], and shortened reaction time [ （478 ± 158） ms vs. （349 ± 144） ms, P 〈0. 01 ] with hyperactivity improvement. And no difference was found with ABR in ADHD children between before and after treatment. Conclusion The prolongation of P300, MMN latency and reaction time may reflect the changes of cognitive performance in initial stage of ADHD. P300, MMN latency and CNV amplitude could be as the indicators for the assessment of methylphenidate treatment.

关 键 词：注意力缺陷障碍伴多动 哌醋甲酯 诱发电位 儿童 

分 类 号：R749.94[医药卫生—神经病学与精神病学]