目的 分析注意缺陷多动障碍(ADHD)患儿口服盐酸哌甲酯缓释片(MPH)治疗中断的影响因素,为提升临床依从性提供科学参考。方法 采用回顾性调查研究,选取2022年8月—2024年3月在首都医科大学附属首都儿童医学中心保健中心ADHD门诊诊断为ADHD并首次接受口服MPH治疗及随访的174例患儿,根据患儿接受MPH治疗是否满6个月进行分组,分为药物保留组和药物中断组。采用斯诺佩评定量表-父母版(SNAP-Ⅳ-P)、视听整合连续操作测试 (IVA-CPT)进行注意力测评,采用独立样本t检验比较两组患儿的SNAP-Ⅳ-P总分、IVA-CPT综合反应控制商数、综合注意力商数得分水平;通过χ2检验、多因素 logistic 回归分析接受口服MPH患儿出现药物中断的影响因素。结果 接受MPH治疗ADHD的患儿共174例,药物中断组患儿71例,其中男48例,女23例,年龄(9.96±1.56)岁;药物保留组患儿103例,其中男85例,女18例,年龄(9.87±1.65)岁。两组患儿在注意力测评中SNAP-Ⅳ-P总分、综合反应控制商数及综合注意力商数得分差异均无统计学意义(P>0.05)。多因素logistic回归模型分析结果显示,女童(OR=2.777, 95%CI 1.276~6.046)、居住地郊区(OR=2.588, 95%CI 1.313~5.099)、有药物不良反应(OR=4.671, 95%CI 2.293~9.297 ),为ADHD患儿药物中断的危险因素(P<0.05),主要带养人文化程度本科、研究生及以上为ADHD患儿药物中断的保护因素(OR=0.118, 0.095,P<0.05)。结论 ADHD患儿MPH药物中断率较高,与儿童性别、居住地、主要带养人文化程度、药物不良反应等影响因素有关,应加强随访管理、用药咨询及不良反应处理,以提升治疗依从性。
Abstract
Objective To analyze factors associated with discontinuation of methylphenidate (MPH) among children with attention-deficit/hyperactivity disorder (ADHD) receiving methylphenidate hydrochloride prolonged-release tablets (MPH), so as to provide a scientific reference for improving clinical adherence. Methods A retrospective study was conducted in 174 children with ADHD who initiated oral MPH treatment for the first time and completed follow-up at the ADHD clinic of the Child Healthcare Center, Capital Center for Children′s Health, Capital Medical University, from August 2022 to March 2024.According to whether treatment was maintained for at least 6 months after initiation, participants were divided into a medication retention group and a medication discontinuation group.The Swanson, Nolan, and Pelham Rating Scale-Parent Version (SNAP-Ⅳ-P) and Integrated Visual and Auditory Continuous Performance Test (IVA-CPT) were adopted to assess attention. Independent-samples t-tests were performed to compare total SNAP-Ⅳ scores, comprehensive response control quotient, and comprehensive attention quotient between the two groups.Multivariate logistic regression analysis and Chi-square test were performed to explore factors associated with MPH treatment discontinuation in orally treated children. Results A total of 174 children with ADHD who received MPH treatment were included in the study.Among them, 71 cases were in the medication discontinuation group, consisting of 48 males and 23 females, with an average age of (9.96±1.56) years.The remaining 103 cases were in the medication retention group, comprising 85 males and 18 females, with an average age of (9.87±1.65) years.No significant differences were found between the two groups in total score of SNAP-Ⅳ-P, comprehensive response control quotient, or comprehensive attention quotient of the IVA-CPT (P>0.05).Multivariate logistic regression showed that girls (OR=2.777, 95%CI: 1.276 - 6.046), residence in suburban areas (OR=2.588, 95%CI: 1.313 - 5.099), and adverse drug reactions (OR=4.671, 95%CI: 2.293 - 9.297) were associated with an increased risk of treatment discontinuation (P＜0.05).A primary caregiver education level of bachelor′s degree (OR=0.118) or postgraduate and above (OR=0.095) was associated with a reduced risk of discontinuation (P＜0.05). Conclusions The rate of MPH discontinuation among children with ADHD is notably high and is significantly associated with factors such as gender, residence place, the educational level of the primary caregiver, and adverse drug reactions.To enhance treatment adherence, it is essential to strengthen follow-up management, provide comprehensive medication counseling, and improve the clinical handling of adverse effects.
关键词
注意缺陷多动障碍 /
盐酸哌甲酯 /
药物中断 /
依从性
Key words
attention-deficit/hyperactivity disorder /
methylphenidate /
medication discontinuation /
compliance
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基金
北京市卫健委“高层次公共卫生人才”建设项目(学科带头人-02-19);北京市医院管理中心“登峰”计划(DFL20221103);北京自然科学基金(7232235)
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