注意缺陷多动障碍与抽动障碍儿童HPA轴功能的变化  

Function of hypothalamus-pituitary-adrenal axis in children with attention deficit hyperactivity disorder and tic disorder

作　　者：陈辉[1] 陈燕惠[1] 刘艳艳[1] 林桂秀[1] 韦立新[2] 陈丹玲[2] 

机构地区：[1]福建医科大学附属协和医院儿科,福建福州350001 [2]福建医科大学附属协和医院检验科,福建福州350001

出　　处：《中国儿童保健杂志》2010年第4期282-284,共3页Chinese Journal of Child Health Care

基　　金：福建医科大学协和临床学院教授基金(JS07008)

摘　　要：【目的】通过对注意缺陷多动障碍(attention deficity hyperactivity disorder,ADHD)、抽动障碍(tic disor-der,TD)、TD共患ADHD儿童的下丘脑-垂体-肾上腺(HPA)轴功能状态进行研究,探讨HPA轴在ADHD、TD及TD共患ADHD中的作用。【方法】TD、ADHD的诊断根据精神障碍与诊断手册第4版(DSM-IV)诊断标准。血浆皮质醇及ACTH检测分别采用全自动微粒酶免疫分析法及电化学发光法,于上午8:00空腹进行。【结果】ADHD组血浆皮质醇水平[(214.43±84.28)nmol/L]低于对照组[(353.32±112.75)nmol/L,P<0.001],而TD组皮质醇水平[(337.54±120.45)nmol/L]与对照组[353.32±112.75)nmol/L]比较差异无统计学意义(P>0.05)。TD共患ADHD组血浆皮质醇水平[(223.30±133.73)nmol/L]较TD组与对照组儿童明显降低(P<0.001),而与ADHD组比较差异无统计学意义。而各组血浆ACTH水平相互进行比较,均无统计学意义。【结论】ADHD儿童以及TD共患ADHD均存在着HPA轴调节功能障碍,而TD的HPA轴调节功能正常。血浆皮质醇与抽动症状相关性小,而与注意缺陷、多动、冲动行为关系更为密切。【Objective】 To explore the role of the HPA axis in the pathogenesis of attention deficit hyperactivity disorder（ADHD）,tic disorder（TD） and TD comorbid with ADHD,the function of HPA axis in children with ADHD,TD and TD comorbid with ADHD has been investigated. 【Methods】 Male children with ADHD or TD at the age between 6 and 12 years old were diagnosed according to DSM-IV in this study.At 8：00 am,the levels of plasma cortisol and ACTH were evaluated by automatic particle enzyme immunoassay and electrochemiluminescence separatel 【Results】 Compared with those in the control group [（353.32±112.75）nmol/L],the children in ADHD group [（214.43±84.28）nmol/L） had lower level of plasma cortisol（P〈0.001）.The children in TD comorbid with ADHD group [（223.30±133.73）nmol/L] also had lower level of cortisol comparing with those in pure TD group [（337.54±120.45）nmol/L,P〈0.001] and control group（P0.001）.But there was no significant difference in the level of plasma cortisol between the pure TD group and the control group or between the TD comorbid with ADHD group and the ADHD group.There was no significant differences in the concentration of plasma ACTH among the four groups（P〉0.05）. 【Conclusions】 Both children with ADHD and TD comorbid with ADHD exist dysfunction of HPA,but pure TD children has normal function of HPA.Plasma cortisol less impact on the behavior of children with TD,but it may closely be related to attention deficit,hyperactivity and impulsive behavior of children.

关 键 词：注意缺陷多动障碍 抽动障碍 促肾腺素皮质激素 

分 类 号：R749.94[医药卫生—神经病学与精神病学]