经哌醋甲酯系统治疗有效的儿童注意缺陷多动障碍患者停药后静息态功能磁共振变化的研究  

Study on the changes of resting state fMRI after discontinuation of medication in children with attention deficit hyperactivity disorder who are systemically treated and respond to methylphenidate

作　　者：王少华 周惠至 杨晨[2] 杨润许 孙宁 韩冬 张琨[2] 陈诗 康传媛[2] WANG Shao-hua;ZHOU Hui-zhi;YANG Chen;YANG Run-xu;SUN Ning;HAN Dong;ZHANG Kun;CHEN Shi;KANG Chuan-yuan(The Affiliated Mental Health Center of Zhejiang University School of Medicine (The Seventh People's Hospital in Hangzhou),Hangzhou 310000,China)

机构地区：[1]浙江大学医学院附属精神卫生中心(杭州市第七人民医院)儿少心理科,杭州310000 [2]昆明医科大学第一附属医院精神科

出　　处：《临床精神医学杂志》2021年第5期365-369,共5页Journal of Clinical Psychiatry

基　　金：国家自然科学基金(81460218,30900488);国家科技支撑计划项目(2015BAI13B01)。

摘　　要：目的:探讨经哌醋甲酯系统治疗有效的注意缺陷多动障碍(ADHD)患儿在停药后静息态脑功能及临床症状的变化及其影响因素。方法:收集13例经哌醋甲酯系统治疗有效的ADHD患儿(服药有效组)及12例未服药ADHD患者(对照组)的一般资料及ADHD症状分级父母评量表(ARS)评估,采用静息态功能磁共振(rs-fMRI)收集服药有效组服药期、停药期及对照组的脑功能数据。采用局部一致性(ReHo)、功能连接比较脑功能差异。结果:服药有效组停药后ARS总分上升(P<0.05),年龄与停药后ARS加分率呈负相关(P<0.05)。服药有效组停药后在左侧眶部额下回、左侧眶部额中回、右侧前扣带和旁扣带脑回、右侧背外侧额上回、右侧内侧额上回等脑区ReHo值变低,而在小脑脑区ReHo值升高(P均<0.05)。结论:经哌醋甲酯系统治疗有效的ADHD患者在停药后临床症状及静息态脑功能均会出现不同程度的加重或衰退,率先出现衰退的脑区集中在前额叶及前扣带回;年龄可能是停药后临床症状加重程度的影响因素。Objective:To explore the changes of resting brain function and clinical symptoms and its influencing factors in children with attention deficit hyperactivity disorder(ADHD)after treatment with methylphenidate system.Method:The general data and Attention Deficit Hyperactivity Disorder Rating Scale-IV Home Version(ARS)assessment of 13 children with ADHD who have been effectively treated with methylphenidate system(effective group)and 12 cases of ADHD without medication(control group)were collected,and resting state function MRI(rs-fMRI)technology was used to collect brain function data of patients in the effective group during the medication period,withdrawal period and the control group.The method of regional homogeneity(ReHo)and functional connection(FC)was used to compare differences in brain function.Results:The total score of ARS in the effective group increased after drug withdrawal(P<0.05).The older the age,the lower the growth rate of ARS after drug withdrawal(P<0.05).In the effective group,the ReHo value in the brain areas such as the left orbital inferior frontal gyrus,the left orbital middle frontal gyrus,the right anterior cingulate and lateral cingulate gyrus,the right dorsolateral superior frontal gyrus,and the right superior frontal gyrus decreased,while the ReHo value in the cerebellar brain area increased(all P<0.05).Conclusion:The clinical symptoms and resting brain function of ADHD patients who have been effectively treated by methylphenidate system are aggravated or degraded to varying degrees after drug withdrawal.The brain areas which are the first to degenerate are concentrated in the prefrontal gyrus and anterior cingulate gyrus.Age may be a factor influencing the severity of clinical symptoms after drug withdrawal.

关 键 词：注意缺陷多动障碍 哌醋甲酯 静息态功能磁共振 

分 类 号：R749.94[医药卫生—神经病学与精神病学]