注意缺陷多动障碍儿童工作记忆功能的脑近红外成像研究  

Working memory in children with attention deficit hyperactivity disorder:a near-infrared spectroscopy study

作　　者：肖婷[1] 柯晓燕[1] 苏艳丽[1] 潘恒足[2] 杨宏宇[2] 洪珊珊[2] 杭跃跃[1] 储康康[1] 

机构地区：[1]南京医科大学附属脑科医院,南京210029 [2]东南大学儿童发展与学习科学教育部重点试验室,南京210096

出　　处：《中国实用儿科杂志》2010年第12期924-927,共4页Chinese Journal of Practical Pediatrics

基　　金：江苏省卫生科研项目(项目号:H200948)

摘　　要：目的探讨注意缺陷多动障碍(ADHD)患儿工作记忆特征及其相应的脑机制。方法选取2008年4月至10月的39例为南京医科大学附属脑科医院儿童心理卫生研究中心就诊的ADHD患儿,其中注意缺陷型(ADHD-I)14例,多动-冲动型(ADHD-HI)11例,混合型(ADHD-C)14例,同时选取年龄、智商、性别匹配的19名正常儿童为对照组。运用视空间工作记忆范式(包括观察任务、反应任务以及比较任务)进行工作记忆测试,同时采用功能近红外光学成像技术(NIRS)检测两组儿童在执行工作记忆任务时大脑前额叶含氧血红蛋白的差异,运用多变量方差分析进行统计分析。结果行为学研究发现:(1)ADHD患儿工作记忆任务的总错误数及比较任务错误均高于对照组,差异有统计学意义(P<0.05)。(2)两组在执行工作记忆任务时的平均反应时差异无统计学意义,但ADHD患儿执行反应任务时平均反应时较执行比较任务时平均反应时短,差异有统计学意义(P<0.05)。(3)ADHD-C型反应任务错误数显著高于ADHD-HI型(P<0.05);在比较任务错误数方面,ADHD-HI型明显高于ADHD-C型(P<0.05),ADHD-I也明显高于ADHD-C型(P<0.05),但ADHD-HI型与ADHD-I型之间差异无统计学意义。(4)ADHD-HI型执行反应任务和比较任务时的平均反应时均显著高于ADHD-I型(P<0.05)。NIRS研究发现:(1)ADHD在执行两种工作记忆任务时前额叶含氧血红蛋白激活量与对照组差异无统计学意义;(2)ADHD-C型儿童在执行反应任务时左下侧前额叶含氧血红蛋白激活量较ADHD-I型降低[(-2.46±9.62)×10-4au对(10.47±14.18)×10-4au],差异具有统计学意义(P<0.05)。结论 ADHD患儿存在工作记忆缺陷,且不同亚型ADHD患儿完成工作记忆任务时脑前额叶的功能存在差异。Objective To investigate the working memory profiles in children with Attention Deficit Hyperactivity Disorder（ADHD）.Methods We investigated 39 children with ADHD（DSM-IV）,including ADHD combined type（ADHD-C）（n = 14）,ADHD inattentive type（ADHD-I）（n = 14）and ADHD hyperactive/impulsive type（ADHD-HI）（n = 11）,and 19 normal controls matched for age,sex,handedness,and intelligence during a working memory task.Prefrontal brain activity was measured by concentration changes of oxygenated haemoglobin（oxyHb）.Functional near-infrared spectroscopy（NIRS）was used to obtain the oxyHb.Results The results of working memory task：（1）ADHD children had more total errors（3.51±3.025）and comparison errors（2.41±2.149）than controls（P〈0.05）.（2）There was no significant difference in reaction time between ADHD and control group（P〉0.05）.（3）ADHD-C patients had more reaction errors（1.71±2.016）than ADHD-HI＇s（P 〈0.05）;on comparison errors,ADHD-HI children had more than ADHD-C＇s（P 0.05）,and ADHD-I children also had more than ADHD-C＇s（P〈 0.05）.But there was no significant difference between ADHD-I and ADHD-HI group.（4）ADHD-HI group had longer reaction time than ADHD-I＇s（P 〈0.05）.The results of NIRS：（1）There was no significant difference in concentration changes of oxygenated haemoglobin（oxyHb）between ADHD and control group when they performed working memory task.（2）Concentration levels of oxyHb in ADHD-C decreased in the left-down prefrontal cortex area during performing reaction commission than ADHD-I[（-2.46±9.62）×10^-4 vs.（10.47±14.18）×10^-4 P 0.05].Conclusion There are significant deficiencies in working memory in children with ADHD;ADHD subtypes differ in working memory profile.

关 键 词：注意缺陷多动障碍 亚型 工作记忆 近红外光学成像 前额叶 

分 类 号：R72[医药卫生—儿科]