近红外脑功能成像技术结合行为评估在注意缺陷多动障碍诊断中的效能分析  

Diagnostic performance of functional near-infrared spectroscopy combined with behavioral assessment in attention-deficit hyperactivity disorder

作　　者：张茜[1] 任姣姣 高红 白瑞北 王朝晖[1,2] ZHANG Xi;REN Jiaojiao;GAO Hong;BAI Ruibei;WANG Zhaohui(The First Clinical Medical School,Shaanxi University of Chinese Medicine,Xianyang,Shaanxi 712099,China;The Children's Health Department,Xi'an People's Hospital(Xi'an Fourth Hospital))

机构地区：[1]陕西中医药大学,第一临床医学院,陕西咸阳712099 [2]西安市人民医院(西安市第四医院)儿童保健科

出　　处：《中国儿童保健杂志》2025年第4期402-408,共7页Chinese Journal of Child Health Care

基　　金：陕西省科技厅研究项目(2022SF-519)。

摘　　要：目的采用近红外脑功能成像技术(fNIRS)探索注意缺陷多动障碍(ADHD)儿童在任务态下前额叶皮层(PFC)脑激活水平,及其与行为评估方法结合后在ADHD中的区分能力及诊断价值,为ADHD的早期诊断提供依据。方法选取2023年7月—2024年7月在西安市人民医院(西安市第四医院)儿童保健科就诊的40例ADHD儿童和同期来院健康体检的30名健康儿童为研究对象,在言语流畅性任务(VFT)下采用22通道fNIRS设备采集前额叶氧合血红蛋白(HbO_(2))浓度变化以反映其PFC的激活情况。完成Conners父母症状问卷(PSQ),将PSQ与前额叶HbO_(2)值进行相关性及受试者工作特征曲线(ROC)分析,以探讨HbO_(2)联合PSQ在ADHD诊断中的敏感度和特异度。结果ADHD儿童在右侧背外侧前额叶皮层(rDLPFC)、左侧背外侧前额叶皮层(lDLPFC)、右侧额极皮层(rFPC)、内侧前额叶皮层(mFPC)、布罗德曼8区(BA8)的HbO_(2)水平低于健康儿童(Z=4.115、2.363、3.591、2.578、2.936,P<0.05),ADHD儿童在PSQ评估中的品行、学习问题、冲动-多动、多动指数各因子分均高于健康组儿童(Z=3.827、4.065、5.531、4.827,P<0.05)。学习问题与rDLPFC、rFPC、mFPC的HbO_(2)呈负相关(r=-0.336、-0.412、-0.310,P<0.05),冲动-多动与mFPC的HbO_(2)呈负相关(r=-0.382,P<0.05),多动指数与rDLPFC、rFPC、mFPC、BA8的HbO_(2)呈负相关(r=-0.393、-0.445、-0.431、-0.339,P<0.05)。rDLPFC、lDLPFC、rPFC、lPFC、mPFC、BA8脑区的HbO_(2)联合多动指数的ROC曲线的AUC分别为0.884、0.877、0.883、0.900、0.896、0.884,均大于HbO_(2)及多动指数单独预测的AUC。结论ADHD儿童PFC功能受损,前额叶HbO_(2)值联合PSQ在ADHD诊断中具有价值。Objective To explore the prefrontal cortex(PFC)activation levels in children with attention deficit hyperactivity disorder(ADHD)during task states using functional near-infrared spectroscopy(fNIRS),and to evaluate the diagnostic value of combining PFC activation with behavioral assessments for distinguishing ADHD,so as to provide a basis for early diagnosis.Methods A total of 40 children diagnosed with ADHD and 30 healthy children undergoing routine health check-ups atthe Children's Health Department of Xi'an People's Hospital(Xi'an Fourth Hospital)from July 2023 to July 2024 were recruited.A 22-channel fNIRS device was used to measure changes in oxygenated hemoglobin(HbO_(2))concentration in the PFC during a verbal fluency task(VFT).The Conners Parent Symptom Questionnaire(PSQ)was administered,and correlations between PSQ scores and PFC HbO_(2) levels were analyzed.Receiver operating characteristic(ROC)curve analysis was performed to assess the sensitivity and specificity of combining HbO_(2) levels with PSQ scores for ADHD diagnosis.Results Compared to healthy children,ADHD children exhibited significantly lower HbO_(2) levels in the right dorsolateral prefrontal cortex(rDLPFC),left dorsolateral prefrontal cortex(lDLPFC),right frontopolar cortex(rFPC),medial prefrontal cortex(mFPC),and Brodmann area 8(BA8)(Z=4.115,2.363,3.591,2.578,2.936,P<0.05).ADHD children also scored higher on the PSQ subscales for conduct problems,learning problems,impulsivity-hyperactivity,and hyperactivity index(Z=3.827,4.065,5.531,4.827,P<0.05).Negative correlations were observed between learning problems and HbO_(2) levels in the rDLPFC,rFPC,and mFPC(r=-0.336,-0.412,-0.310,P<0.05),between impulsivity-hyperactivity and HbO_(2) levels in the mFPC(r=-0.382,P<0.05),and between the hyperactivity index and HbO_(2) levels in the rDLPFC,rFPC,mFPC,and BA8(r=-0.393,-0.445,-0.431,-0.339,P<0.05).The area under the ROC curve(AUC)for the combined prediction of ADHD using HbO_(2) levels in the rDLPFC,lDLPFC,rFPC,lFPC,mFPC,and BA8 along with the hyper

关 键 词：注意缺陷多动障碍 近红外光谱成像 前额叶皮层 氧合血红蛋白 行为评估 

分 类 号：R749.94[医药卫生—神经病学与精神病学]