CAJ | 학술논문

背景:对立违抗障碍( ODD)以对抗等行为为特征,常与注意缺陷多动障碍( ADHD)并存.有研究报道 ADHD合并 ODD比单纯 ADHD有更广泛的损害;有研究认为血清低 5 羟色胺水平可能与 ADHD的攻击性行为有关,国内报道较少. 目的:探讨 ADHD合并 ODD的临床特征及与 5 羟色胺的关系. 设计: 2002- 06/2003- 05以伴有和不伴有 ODD的 ADHD患儿为研究对象的对照性研究. 单位:湘雅二医院精神卫生研究所. 对象:研究对象来源于 2002- 06/2003- 05在中南大学儿童精神卫生专科门诊就诊的 7 14岁 ADHD患儿共 61例(男 53例,女 8例),按 DSM Ⅳ关于对立违抗障碍的症状学标准,将 ADHD儿童分为不伴 ODD组( n=33, ADHD组)和伴 ODD组( n=28, ADHD+ ODD组). 方法:由患儿父母( n=61)填写 Achenbach儿童行为量表( CBCL),由班主任 (n=31)填写教师报告表( TRF),检测当日早餐被试者进不含巧克力、牛奶的正常饮食,空腹采静脉血 2 mL,用外标法定量测定 5 HT浓度,采用 LD 10AD高效液相色谱仪测定. 主要观察指标:伴有和不伴有 ADHD儿童 CBCL, TRF、中国韦氏儿童智力量表 (C WISC),以及血清 5 羟色胺水平差异. 结果:经父母和教师评定, ADHD+ ODD组在 CBCL和 TRF攻击性行为分量表、外向性行为问题及行为问题总分显著高于单纯 ADHD组,差异有显著性意义( t=2.28～ 3.76, P< 0.05～ 0.01); ADHD+ ODD组 CBCL的焦虑 /抑郁及内向性行为问题也明显高于 ADHD组,差异有显著性意义( t=2.27～ 2.35, P< 0.05). ADHD+ ODD组的血清 5 羟色胺水平 [(327.01± 164.84)μ g/L]低于 ADHD组 [(451.11± 250.89)μ g/L], 差异有显著性意义( t=2.32, P< 0.05). 结论: ADHD+ ODD儿童在内、外向性问题和适应能力、注意力诸方面均有损害;攻击性行为和 5 羟色胺降低可能是 ADHD+ ODD儿童冲动行为的生物学标记.
배경:대립위항장애( ODD)이대항등행위위특정,상여주의결함다동장애( ADHD)병존.유연구보도 ADHD합병 ODD비단순 ADHD유경엄범적손해;유연구인위혈청저 5 간색알수평가능여 ADHD적공격성행위유관,국내보도교소. 목적:탐토 ADHD합병 ODD적림상특정급여 5 간색알적관계. 설계: 2002- 06/2003- 05이반유화불반유 ODD적 ADHD환인위연구대상적대조성연구. 단위:상아이의원정신위생연구소. 대상:연구대상래원우 2002- 06/2003- 05재중남대학인동정신위생전과문진취진적 7 14세 ADHD환인공 61례(남 53례,녀 8례),안 DSM Ⅳ관우대립위항장애적증상학표준,장 ADHD인동분위불반 ODD조( n=33, ADHD조)화반 ODD조( n=28, ADHD+ ODD조). 방법:유환인부모( n=61)전사 Achenbach인동행위량표( CBCL),유반주임 (n=31)전사교사보고표( TRF),검측당일조찬피시자진불함교극력、우내적정상음식,공복채정맥혈 2 mL,용외표법정량측정 5 HT농도,채용 LD 10AD고효액상색보의측정. 주요관찰지표:반유화불반유 ADHD인동 CBCL, TRF、중국위씨인동지역량표 (C WISC),이급혈청 5 간색알수평차이. 결과:경부모화교사평정, ADHD+ ODD조재 CBCL화 TRF공격성행위분량표、외향성행위문제급행위문제총분현저고우단순 ADHD조,차이유현저성의의( t=2.28～ 3.76, P< 0.05～ 0.01); ADHD+ ODD조 CBCL적초필 /억욱급내향성행위문제야명현고우 ADHD조,차이유현저성의의( t=2.27～ 2.35, P< 0.05). ADHD+ ODD조적혈청 5 간색알수평 [(327.01± 164.84)μ g/L]저우 ADHD조 [(451.11± 250.89)μ g/L], 차이유현저성의의( t=2.32, P< 0.05). 결론: ADHD+ ODD인동재내、외향성문제화괄응능력、주의력제방면균유손해;공격성행위화 5 간색알강저가능시 ADHD+ ODD인동충동행위적생물학표기.
BACKGROUND:Oppositional defiant disorder(ODD) often occurs as a comorbid condition of attention deficit hyperactivity disorder(ADHD),characterized by defiant behaviors.ADHD children with ODD have more extensive impairments than those with ADHD alone. Some studies suggest that decreased serum 5 hydroxytryptamine(5 HT) level is related to aggressive behavior in ADHD, but no relevant report is available in China. OBJECTIVE:To investigate the clinical features of ADHD with ODD,and their relations with serum 5 HT. DESIGN:A randomized case controlled study taking the ADHD children with or without ODD as the subjects for study. SETTING:Mental Health Institute of the Second Xiangya Hospital. PARTICIPANTS:Sixty one ADHD children(53 boys and 8 girls) aged 7 to 14 years visiting the Children's Clinic of Mental Health Institute of Central South University from June 2002 to May 2003 were recruited and divided into two groups based on the symptomatic criteria of ODD recommended by the Diagnostic and Statistical Manual of Mental Disorder(DSM Ⅳ ):ADHD group(n=33,without ODD) and ADHD+ ODD group(n=28). INTERVENTIONS:The parents of the enrolled children(n=61) were asked to complete the Achenbach child behavior checklist (CBCL),and the teachers(n=31) completed the teacher's report form (TRF).Two milliliters of fasting venous blood was drawn from these children and the serum separated by centrifugation for quantification of 5 HT using external standard method,and whole blood 5 HT was analyzed by LD 10AD high performance liquid chromatography(HPLC). MAIN OUTCOME MEASURES:Scores of CBCL,TRF and Chinese Wechsler Intelligence Scale for Children(C WISC) and serum 5 HT levels. RESULTS:In the ADHD+ ODD group,the scores of CBCL and TRF for externalizing, aggressive behaviors and total scores for behavioral problems rated by the parents and teachers were significantly higher than those of the ADHD group(t=2.28 to 3.76,P< 0.05 to 0.01);the former group also had significantly higher scores of CBCL for anxiety/depression and internalizing(t=2.27 to 2.35,P< 0.05), but had significantly lower serum 5 HT level[(327.01± 164.84) μ g/L vs (451.11± 250.89) μ g/L](t=2.32,P< 0.05). CONCLUSION:Children with ADHD and comorbid ODD receive poorer ratings on all variables including externalizing and internalizing problems,adjustment variables and attention impairment. Increased aggressive behavior and lowered 5 HT level may be the biological markers of impulsive behavior in ADHD children with ODD.