不同亚型注意缺陷多动障碍男童脑血流特征及其与执行功能的关系  

Cerebral Blood Flow Characteristics of Boys with Different Subtypes of Attention Deficit Hyperactivity Disorder and Their Relationship with Executive Function

作　　者：张心怡 刘宁宁 李海梅[1,2] 王玉凤 刘璐[1,2] 钱秋谨[1,2] ZHANG Xinyi;LIU Ningning;LI Haimei;WANG Yufeng;LIU Lu;QIAN Qiujin(Peking University Sixth Hospital,Peking University Institute of Mental Health,Beijing 100191,China;NHC Key Laboratory of Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking University Sixth Hospital),Beijing 100191,China)

机构地区：[1]北京大学第六医院北京大学精神卫生研究所,北京100191 [2]国家卫生健康委员会精神卫生学重点实验室(北京大学)国家精神心理疾病临床医学研究中心(北京大学第六医院),北京100191

出　　处：《协和医学杂志》2025年第2期314-320,共7页Medical Journal of Peking Union Medical College Hospital

基　　金：国家自然科学基金面上项目(81571340,81873802,82271575);首都卫生发展科研专项(2022-2-4114);北京市科技新星计划(20220484061);北京大学临床医学+X青年学者项目(PKU2023LCXQ043);北京市卫健委第三批研究型病房项目。

摘　　要：目的基于动脉自旋标记(arterial spin labeling,ASL)技术分析不同亚型注意缺陷多动障碍(attention deficit and hyperactive disorder,ADHD)患儿脑血流(cerebral blood flow,CBF)特征差异及其与执行功能的关系。方法本研究为病例对照研究。以2015年7月—2019年12月北京大学第六医院门诊就诊的ADHD患儿为ADHD组,并以2021年1月—12月普通中小学在读学生为健康对照组。两组均完成伪连续ASL序列扫描以测定CBF,并采用执行功能行为评定量表(behavior rating inventory of executive function,BRIEF)家长版评估执行功能。比较不同亚型ADHD患儿与健康对照儿童CBF差异。对于存在组间差异的脑区,提取其CBF值,与BRIEF评分构建线性回归模型,以进一步明确差异脑区与执行功能之间的关系。结果最终纳入ADHD男童134例[注意缺陷为主型ADHD(ADHD predominantly inattentive subtype,ADHD-I)83例,混合型ADHD(ADHD combined subtype,ADHD-C)51例],健康对照男童25名。组间比较显示,ADHD-C患儿左侧颞中回CBF较ADHD-I患儿(P=0.010)、健康对照儿童(P<0.001)显著降低,而ADHD-I患儿与健康对照儿童之间无显著差异(P=0.280)。线性回归模型校正月龄、总智商评分后显示,ADHD-C患儿左侧颞中回CBF与BRIEF中的计划/组织评分呈负相关(β=-0.062,P=0.030)。结论ADHD-C男童左侧颞中回CBF显著低于ADHD-I男童和健康对照男童,且降低的局部CBF可能与ADHD-C在组织和计划能力方面的执行功能缺陷有关,该结果为进一步理解ADHD亚型的神经生物学机制提供了新视角。Objective To analyze the differences in cerebral blood flow(CBF)characteristics among children with different subtypes of attention deficit and hyperactivity disorder(ADHD)and their relationship with executive function using arterial spin labeling(ASL)technology.Methods A case⁃control study was conducted,including children diagnosed with ADHD at the outpatient clinic of Peking University Sixth Hospital from July 2015 to December 2019 as the ADHD group,and typically developing schoolchildren from January to December 2021 as the healthy control group.Both groups underwent pseudo⁃continuous ASL(pCASL)scanning to measure CBF,and executive function was assessed using the parent version of the Behavior Rating Inventory of Executive Function(BRIEF).Differences in CBF between ADHD children and healthy controls were com⁃pared.For brain regions showing significant group differences,CBF values were extracted and linear regression models were constructed with BRIEF scores to further explore the relationship between regional CBF and execu⁃tive function.Results A total of 134 boys with ADHD were included[83 with ADHD predominantly inat⁃tentive subtype(ADHD⁃I)and 51 with ADHD combined subtype(ADHD⁃C)],along with 25 healthy control boys.Intergroup comparisons revealed that the CBF in the left middle temporal gyrus was significantly lower in ADHD⁃C children compared to both ADHD⁃I children(P=0.010)and healthy controls(P<0.001),while no significant difference was observed between ADHD⁃I children and healthy controls(P=0.280).After adjusting for age and total IQ scores,the linear regression model showed that the CBF in the left middle temporal gyrus of ADHD⁃C children was negatively correlated with the planning/organization score on the BRIEF(β=-0.062,P=0.030).Conclusions The CBF in the left middle temporal gyrus of boys with ADHD⁃C is significantly lower than that of boys with ADHD⁃I and healthy controls.This reduced regional CBF may be associated with executive function deficits in organization and plan

关 键 词：注意缺陷多动障碍 亚型 脑血流 执行功能 磁共振成像 

分 类 号：R749.94[医药卫生—神经病学与精神病学] R749.2[医药卫生—临床医学]