注意缺陷多动障碍患儿血清儿茶酚胺类递质的测定  

Measurement of serum catecholamines in boys with attention deficit hyperactivity disorder

作　　者：杜亚松[1,2,3] 苏林雁[1,2,3] 李雪荣[1,2,3] 杨德森 夏令伟[1,2,3] 梁绍先 邓富良[1,2,3] 

机构地区：[1]湖南医科大学精神卫生研究所 [2]上海市精神卫生中心 [3]湖南医科大学分析测试中心

出　　处：《中华精神科杂志》1998年第1期30-33,共4页Chinese Journal of Psychiatry

基　　金：卫生部青年基金

摘　　要：目的探讨注意缺陷多动障碍（ＡＤＨＤ）可能的精神生化机制。方法采用高效液相色谱法，测定了经哌醋甲酯治疗后的６４例ＡＤＨＤ男性患儿和３０名正常男性儿童的血清儿茶酚胺类递质及其代谢产物水平。结果ＡＤＨＤ患儿血清去甲肾上腺素（ＮＥ）水平和ＮＥ／３－甲氧－４－羟苯乙二醇（ＭＨＰＧ）比值（２７±１８）低于正常儿童（１５２±５７），血清高香草酸水平（３．９±２．９μｇ／Ｌ）高于正常儿童（０．８±０．３μｇ／Ｌ）；经哌醋甲酯治疗有效者血清ＭＨＰＧ水平（１３±１０μｇ／Ｌ）高于无效者（８±５μｇ／Ｌ）；智力发育不平衡组血清ＮＥ水平（８４±４３μｇ／Ｌ）低于智力发育平衡组（８９±５８μｇ／Ｌ）；根据美国精神障碍诊断统计手册第３版修订本，将病情分为轻度、中度和重度，重度ＡＤＨＤ患儿血清ＮＥ水平（８２±４５μｇ／Ｌ）明显低于轻度（１０５±５９μｇ／Ｌ）。结论ＡＤＨＤ可能是多巴胺能和去甲肾上腺素能两种递质系统失调或失衡的结果。Objective The aim of this study was to explore the possible pathophysiological mechanism in attention deficit hyperactivity disorder (ADHD). Methods Serum catecholaminergic neurotransmitters and their metabolites in 64 boys with ADHD and 30 normal controls were measured with high performance liquid chromatography. Results ADHD group had significantly lower serum norepinephine (NE) level and lower ratio of NE/MHPG (3 methoxy 4 hydroxyphenylglycol;27±18), but higher homovanilic acid (HVA) level (3.9±2.9 μg/L)than control group (0.8±0.3 μg/L). The responders had significantly higher serum MHPG level(13±10 μg/L) than non responders (8±5 μg/L) after methylphenidate treatment. According to DSM Ⅲ R criteria, children with ADHD were divided into mild, moderate and severe subgroups. Serum NE level in severe subgroup (82±45 μg/L)was significantly lower than that in mild subgroups (105±59 μg/L). Conclusion Dysfunction or imbalance between noradrenergic and dopaminergic neurotransmitter systems might play an leading role in the pathophysiological mechanism of ADHD.

关 键 词：脑损伤综合征 儿茶酚胺 儿童 测定 缺陷多动障碍 

分 类 号：R748.04[医药卫生—神经病学与精神病学]