目的 分析基于近红外光谱成像的注意缺陷多动障碍(ADHD)患儿的前额叶皮质功能,为ADHD的脑功能分析提供参考依据。方法 选取2019年7月-2020年2月就诊于上海市儿童医院儿童保健科ADHD门诊及体检门诊的各100名儿童,由家长填写ADHD评估量表和人口学资料,临床医师进行综合访谈和体格检查,治疗师进行韦氏智力测试及基于近红外光谱的前额叶皮质功能检测。结果 选取筛选后的有效样本共70名儿童,35名为确诊ADHD的患儿,匹配同期(年龄及性别相仿)的35名正常对照儿童。ADHD组平均年龄(8.2±1.3)岁,正常对照组平均年龄(8.9±1.0)岁,ADHD组和对照组左侧前额叶皮质氧和血红蛋白浓度统计值分别为-0.005±0.033、0.020±0.021,两组间差异具有统计学意义(t=3.781, P<0.001)。在ADHD组患儿中,左侧脑皮质激活明显低于右侧(t=2.272,P<0.05),不同性别和年龄段ADHD患儿前额叶皮质功能水平差异均无统计学意义(P＞0.05),不同亚型ADHD患儿右侧前额叶皮质功能差异有统计学意义(F=7.138,P<0.01),多动冲动型患儿可能存在右侧前额叶皮质功能补偿。结论 ADHD患儿存在左侧前额叶皮质功能受损,前额叶皮质功能水平与年龄及性别无明显相关性。
Abstract
Objective To analyze the prefrontal cortex function of children with attention deficit hyperactivity disorder (ADHD) based on near-infrared spectroscopy imaging, so as to provide reference for the individual diagnosis and treatment of ADHD. Methods A total of 100 children who visited ADHD clinic and physical examination clinic of Shanghai Children's Hospital from July 2019 to February 2020 were selected.Parents filled in the ADHD assessment scale and demographic data, clinicians conducted comprehensive interviews and physical examination, and the therapist performed Webster intelligence test and prefrontal cortical function test based on near infrared spectroscopy. Results A total of 70 children were selected as effective samples after screening, including 35 children confirmed with ADHD, and 35 normal control children in the same period (with similar age and gender).The average age of the ADHD group and normal control group was (8.2±1.3) and (8.9±1.0) years old, respectively.The oxygen and hemoglobin concentration of the left prefrontal cortex in ADHD group and control group was -0.005±0.033 and 0.020±0.021, respectively, with significant difference (t=3.781, P<0.001).In children with ADHD, the activation of the left cerebral cortex was significantly lower than that of the right (t=2.272, P<0.05), and there were no significant difference on the level of prefrontal cortex among ADHD children in different gender and age groups (P>0.05).Significant difference was found on the function of the right prefrontal cortex in children with different subtypes of ADHD (F=7.138, P<0.01), indicating that ADHD children with hyperactivity and impulsivity may have right frontal cortical function compensation. Conclusions The left prefrontal cortex function is impaired in ADHD children.The function level of the prefrontal cortex has no obvious correlation with age and gender.
关键词
注意缺陷多动障碍 /
近红外光谱 /
前额叶皮层
Key words
attention deficit hyperactivity disorder /
near-infrared spectroscopy /
prefrontal cortex
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参考文献
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基金
国家自然科学基金(81670810);上海市科学技术委员会医学引导类项目(18411967700);上海市科委医学引导类科技支撑项目(19411969000);上海市自然科学基金项目(19ZR1477700);上海市儿童健康服务能力建设专项规划高端儿科海外研修团队培养计划(GDEK201710);上海申康医院发展中心常见疾病适宜技术研发与推广应用项目(16CR4016A);交大医学院儿科硕士研究生临床科研能力提升计划(EKKY2018006DGD)。
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