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(HbO2)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HbO2值进行相关性及受试者工作特征曲线(ROC)分析,以探讨HbO2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HbO2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HbO2呈负相关(r=-0.336、-0.412、-0.310,P<0.05),冲动-多动与mFPC的HbO2呈负相关(r=-0.382,P<0.05),多动指数与rDLPFC、rFPC、mFPC、BA8的HbO2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HbO2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HbO2及多动指数单独预测的AUC。结论 ADHD儿童PFC功能受损,前额叶HbO2值联合PSQ在ADHD诊断中具有价值。
Abstract
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 (HbO2) 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 HbO2 levels were analyzed. Receiver operating characteristic (ROC) curve analysis was performed to assess the sensitivity and specificity of combining HbO2 levels with PSQ scores for ADHD diagnosis. Results Compared to healthy children, ADHD children exhibited significantly lower HbO2 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 HbO2 levels in the rDLPFC, rFPC, and mFPC (r＝-0.336,-0.412,-0.310, P<0.05), between impulsivity-hyperactivity and HbO2 levels in the mFPC (r＝-0.382, P<0.05), and between the hyperactivity index and HbO2 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 HbO2 levels in the rDLPFC, lDLPFC, rFPC, lFPC, mFPC, and BA8 along with the hyperactivity index was 0.884, 0.877, 0.883, 0.900, 0.896, and 0.884, respectively, all of which were higher than the AUCs for HbO2 levels or the hyperactivity index alone. Conclusion Children with ADHD exhibit impaired PFC function, and the combination of PFC HbO2 levels and PSQ scores demonstrates significant diagnostic value for ADHD.
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
Key words
attention-deficit hyperactivity disorder /
near-infrared spectroscopic imaging /
prefrontal cortex /
oxygenated haemoglobin /
behavioral assessment
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基金
陕西省科技厅研究项目(2022SF-519)
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