哌甲酯及托莫西汀对注意缺陷多动障碍儿童HPA轴功能的影响  

The Influences of Methylphenidate and Tomoxetine on the Function of HPA in Children with ADHD

作　　者：陈燕惠[1] 陈辉[1] 刘艳艳[1] 林桂秀[1] 韦立新[1] 洪艳玲[1] 

机构地区：[1]福建医科大学附属协和医院,福建福州350001

出　　处：《儿科药学杂志》2011年第1期20-23,共4页Journal of Pediatric Pharmacy

基　　金：福建医科大学协和临床学院教授基金课题(JS07008)

摘　　要：目的：通过研究哌甲酯（MPH）及托莫西汀（ATX）治疗前后注意缺陷多动障碍（ADHD）儿童下丘脑-垂体-肾上腺（HPA）轴的功能状态,探讨HPA轴在ADHD中的作用。方法：采用前瞻、双盲、随机对照研究方法,根据美国《精神病诊断与统计手册》（第4版）（DSM-IV）ADHD诊断和分型标准确诊111例6~14岁ADHD男童,其中注意缺陷为主型（ADHD-I）33例,多动-冲动为主型（ADHD-HI）30例,混合型（ADHD-C）48例,对照组为年龄匹配健康男童35名。31例ADHD儿童随机给予MPH治疗和ATX治疗,于治疗前和治疗后1个月进行皮质醇测定。血浆皮质醇测定采用全自动微粒酶免疫分析法,于上午8：00空腹抽血测定。结果：ADHD各组血浆皮质醇水平[（236.12±109.77）nmol/L）均较对照组[（353.32±112.75）nmol/L）明显降低（P〈0.01）。ADHD-HI组[（177.62±62.99）nmol/L）]下降程度较ADHD-I组[（246.71±129.27）nmol/L,P〈0.05]及ADHD-C组[（265.41±106.00）nmol/L,P〈0.01]为著。31例ADHD男童,治疗后皮质醇浓度（249.84±87.86）nmol/L高于治疗前的（164.94±48.98）nmol/L（P〈0.001）,而治疗后符合DSM-IV的症状数中位数（M/QR）为10/3分,低于治疗前的12/4分（P〈0.01）。结论：在非应激状态下,ADHD儿童存在着HPA轴调节功能障碍,这可能系HPA轴低反应性所致。哌甲酯和托莫西汀均能提高ADHD患儿的皮质醇水平,皮质醇的提高与行为的改善密切相关。Objective：To explore the relationship between hypothalamus-pituitary-adrenal（HPA） and ADHD.The function of HPA axis in children with ADHD has been investigated before and after the treatment of methylphenidate（MPH） and atomoxetine（ATX）.Methods： The clinical study was a prospective,double-blind,randomized case-control trail.One hundred and eleven male children with ADHD between the ages of 6 to 14 years old were included in this study.The diagnosis of ADHD and its three subtypes were according to the handbook for the diagnosis and treatment of ADHD by American Psychiatric Association（DSM-IV）.Among all the cases there were 33 children with ADHD-predominantly inattention type（ADHD-I）,30 children with ADHD-predominantly hyperactive impulsive type（ADHD-HI） and 48 children with ADHD-combined type（ADHD-C）.Meanwhile,35 healthy male children were in the control group.Thirty one children with ADHD were randomly given MPH and ATX therapy.At 8：00 am,the levels of cortisol were evaluated at pre-treatment and post-treatment by Automatic particle enzyme immunoassay.Results： The level of cortisol in ADHD group [（236.12±109.77） nmol/L] was significantly lower than in the control group [（353.32±112.75） nmol/L]（P0.01）.The level of cortisol was the lowest in ADHD-HI group [（177.62± 62.99） nmol/L] comparing with that in ADHD-I group [（246.71±129.27） nmol/L,P0.05] and ADHD-C group [（265.41±106.00） nmol/L,P0.01].Thirty one children with ADHD after treatment had higher cortisol level [（249.84±87.86） nmol/L] than those before treatment [（164.94±48.98） nmol/L]（P0.01）.However,children with ADHD after treatment had less symptom counts（M/OR,10/3） than those（M/OR,12/4） before treatment（P0.01）.Conclusions： In the non-stress state,children with ADHD exhibited dysfunction of HPA,which may be due to the hyporesponsiveness of HPA.Both MPH and ATX can improve the cortisol level and the elevation of cortisol is closely related to the improvement of the behav

关 键 词：注意缺陷多动障碍 皮质醇 哌甲酯 托莫西汀 儿童 

分 类 号：R971.7[医药卫生—药品]