儿童注意力缺陷多动障碍诱发因素研究
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摘要
目的:从注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)儿童营养、儿童忽视及神经营养因子方面,探讨ADHD儿童发病的有关因素,为儿童ADHD开展有效的防治措施提供科学的依据。
方法:采取自愿的原则,选取至本院儿童保健科就诊的6～10岁儿童,符合美国精神障碍诊断与统计手册第4版(DSM-IV)有关ADHD的诊断标准,为研究组,同时按照性别及年龄进行1:1配对选取健康儿童为正常对照组。
采用瑞文标准智力测验、整合视听连续执行测试(Integrared Visual and Auditory Continous Performance text,IVA-CPT)评估受试儿童的智商以及对ADHD进行分型;采用饮食调查、血清微量元素、血氨、血液酸碱度及相关生化指标的测定来评定受试儿童的膳食结构,营养元素、血氨水平及体液酸碱平衡;采用《中国城区儿童忽视状况评价问卷》评价受试儿童存在的儿童忽视情况,对影响ADHD的身体、情感、教育、安全、医疗五个层面的忽视进行Logistic多元回归分析;采用酶联免疫ELISA法对受试儿童血清中S100β蛋白含量进行测定,评价受试儿童大脑发育成熟状况。
结果:本研究表明①ADHD组儿童热量摄入量、蛋白质和脂肪供热比显著高于正常组儿童,碳水化合物供热比显著低于正常组儿童。
②ADHD组儿童血清镁元素和锌元素含量均低于正常组儿童,而血清钙、铁、铜三种微量元素含量无显著差异性。
③ADHD儿童的血氨水平显著高于正常组儿童。
④ADHD组儿童血液PH值均在正常范围内为7.39±0.03,但较正常组儿童7.41±0.02偏酸性,与体液酸碱平衡相关的SB、Na+和Cl-水平在ADHD组儿童均高于正常组儿童。
⑤多动症组儿童受忽视人数、忽视度显著多于正常组儿童,并且ADHD组儿童身体、情感、教育、医疗的忽视分值高于正常组儿童,而安全层面忽视分值无显著性差异。
⑥6～10岁正常学龄期儿童S100β蛋白含量无性别和年龄差异,平均含量为42.71 pg/ml,标准差为10.76 pg/ml。
⑦ADHD组儿童血清S100β蛋白含量低于正常组儿童,各亚型间血清S100β蛋白含量无显著差异性;儿童的智商和IVT-CPT各商数与血清S100β蛋白含量具有显著的正相关。
结论:本研究显示①儿童膳食结构不合理,营养不均衡,体液酸碱平衡紊乱是ADHD发病的诱发因素。
②ADHD与儿童忽视有关,其中情感、教育、医疗层面的忽视是ADHD发病的主要因素。
③本研究中6～10岁正常学龄期儿童S100β蛋白的含量,可供临床应用。
④ADHD儿童血清中S100β蛋白的含量明显较低,表明S100β蛋白与ADHD有关,进一步提示ADHD与大脑发育障碍有关。
Objective: To examine children nutrition, child neglect and neurotrophic factor on the children with ADHD, to explore the risk factors associated with ADHD so that providing the science bases of the effective prevention and cure.
Methods: According to the principle of willingness, the children aged 6 to 10 years from the child health department, were selected in the clinic, divided into the ADHD group, by the ADHD diagnosis standard in the Fourth Edition of Diagnostic and Statistic Manual of Mental Disorder (DSM-IV) criteria, and the normal group,by means of the principle of 1:1 matching, as same as the sex and age of child in ADHD group.
To examine intelligence quotient (IQ) with Raven’s Standard Progressive Matrices, and to divide ADHD into four subtypes with IVA-CPT, to assess the child's meals structure, nutritive elements, blood ammonia level and body fluid acid-base equilibrium with the diet investigation, blood serum trace element, concentration of blood ammonia, blood PH and the related biochemical indicator, to assess the status of child neglect among the tried child with Evaluation Questionnaire of Child Neglect of Urban Children in China, to analyze physical, emotional, medical, educational and safe neglect situation with Logistic multiple regression analysis, and to measure the concentration of S100βin blood with ELISA method so as to access the child cerebrum growth mature condition.
Result: Our data showed that①The energy intake in the ADHD group were significantly higher than those in the control group. The heats rate of three kind of nutrient indicated that Carbohydrate was insuffcient and protein and fat were excessive in ADHD children.
②There was no difference in the contents of serum calcium, iron, copper between the ADHD and control group, while the contents of serum magnesium and zinc of ADHD children were obviously lower than the control group.
③The blood ammonia level of children in ADHD group was obviously higher than the normal group.
④The blood PH of children in ADHD group and normal group was 7.39±0.03, 7.41±0.02 respectively, the both were in normal range but the former was meta acids than the latter. The SB, Na+ and Cl- levels of children in the ADHD group were higher than the normal group.
⑤The children neglected and neglect degree in ADHD group were more than the normal group. Such as neglect score of physical, emotional, educational and medical neglect subscales of ADHD group were higher than the control group, and the score of safe neglect subscale was not significant difference.
⑥the average content of S100βprotein in 6-10 year old normal school children was 42.71pg/ml, the standard deviation was 10.76 pg/ml, and with no different in sex and age.
⑦The content of serum S100βprotein in children of ADHD group was obviously lower than that of children in normal group, which had obviously positive correlation with IQ and scores of IVT-CPT. There was no remarkable difference in the content of serum S100βprotein during four subtypes.
Conclusion: The data indicated that①The unreasonable meals structure, imbalanced nutrition and body fluid acid-base equilibrium disorder of children were the causative factors of ADHD.
②There was some relation between child neglect and ADHD, especially the emotional , educational and medical neglect subscales were primary hazard factor of ADHD morbidity.
③In our data the content of serum S100βprotein in 6-10 year old normal school children can be applied in clinic.
④Compared with control group, in ADHD group, the content of serum S100βprotein was obviously lower, indicated that there was relation between S100βand ADHD, further prompted the child with ADHD was associated with the brain development immature.
方法:采取自愿的原则,选取至本院儿童保健科就诊的6～10岁儿童,符合美国精神障碍诊断与统计手册第4版(DSM-IV)有关ADHD的诊断标准,为研究组,同时按照性别及年龄进行1:1配对选取健康儿童为正常对照组。
采用瑞文标准智力测验、整合视听连续执行测试(Integrared Visual and Auditory Continous Performance text,IVA-CPT)评估受试儿童的智商以及对ADHD进行分型;采用饮食调查、血清微量元素、血氨、血液酸碱度及相关生化指标的测定来评定受试儿童的膳食结构,营养元素、血氨水平及体液酸碱平衡;采用《中国城区儿童忽视状况评价问卷》评价受试儿童存在的儿童忽视情况,对影响ADHD的身体、情感、教育、安全、医疗五个层面的忽视进行Logistic多元回归分析;采用酶联免疫ELISA法对受试儿童血清中S100β蛋白含量进行测定,评价受试儿童大脑发育成熟状况。
结果:本研究表明①ADHD组儿童热量摄入量、蛋白质和脂肪供热比显著高于正常组儿童,碳水化合物供热比显著低于正常组儿童。
②ADHD组儿童血清镁元素和锌元素含量均低于正常组儿童,而血清钙、铁、铜三种微量元素含量无显著差异性。
③ADHD儿童的血氨水平显著高于正常组儿童。
④ADHD组儿童血液PH值均在正常范围内为7.39±0.03,但较正常组儿童7.41±0.02偏酸性,与体液酸碱平衡相关的SB、Na+和Cl-水平在ADHD组儿童均高于正常组儿童。
⑤多动症组儿童受忽视人数、忽视度显著多于正常组儿童,并且ADHD组儿童身体、情感、教育、医疗的忽视分值高于正常组儿童,而安全层面忽视分值无显著性差异。
⑥6～10岁正常学龄期儿童S100β蛋白含量无性别和年龄差异,平均含量为42.71 pg/ml,标准差为10.76 pg/ml。
⑦ADHD组儿童血清S100β蛋白含量低于正常组儿童,各亚型间血清S100β蛋白含量无显著差异性;儿童的智商和IVT-CPT各商数与血清S100β蛋白含量具有显著的正相关。
结论:本研究显示①儿童膳食结构不合理,营养不均衡,体液酸碱平衡紊乱是ADHD发病的诱发因素。
②ADHD与儿童忽视有关,其中情感、教育、医疗层面的忽视是ADHD发病的主要因素。
③本研究中6～10岁正常学龄期儿童S100β蛋白的含量,可供临床应用。
④ADHD儿童血清中S100β蛋白的含量明显较低,表明S100β蛋白与ADHD有关,进一步提示ADHD与大脑发育障碍有关。
Objective: To examine children nutrition, child neglect and neurotrophic factor on the children with ADHD, to explore the risk factors associated with ADHD so that providing the science bases of the effective prevention and cure.
Methods: According to the principle of willingness, the children aged 6 to 10 years from the child health department, were selected in the clinic, divided into the ADHD group, by the ADHD diagnosis standard in the Fourth Edition of Diagnostic and Statistic Manual of Mental Disorder (DSM-IV) criteria, and the normal group,by means of the principle of 1:1 matching, as same as the sex and age of child in ADHD group.
To examine intelligence quotient (IQ) with Raven’s Standard Progressive Matrices, and to divide ADHD into four subtypes with IVA-CPT, to assess the child's meals structure, nutritive elements, blood ammonia level and body fluid acid-base equilibrium with the diet investigation, blood serum trace element, concentration of blood ammonia, blood PH and the related biochemical indicator, to assess the status of child neglect among the tried child with Evaluation Questionnaire of Child Neglect of Urban Children in China, to analyze physical, emotional, medical, educational and safe neglect situation with Logistic multiple regression analysis, and to measure the concentration of S100βin blood with ELISA method so as to access the child cerebrum growth mature condition.
Result: Our data showed that①The energy intake in the ADHD group were significantly higher than those in the control group. The heats rate of three kind of nutrient indicated that Carbohydrate was insuffcient and protein and fat were excessive in ADHD children.
②There was no difference in the contents of serum calcium, iron, copper between the ADHD and control group, while the contents of serum magnesium and zinc of ADHD children were obviously lower than the control group.
③The blood ammonia level of children in ADHD group was obviously higher than the normal group.
④The blood PH of children in ADHD group and normal group was 7.39±0.03, 7.41±0.02 respectively, the both were in normal range but the former was meta acids than the latter. The SB, Na+ and Cl- levels of children in the ADHD group were higher than the normal group.
⑤The children neglected and neglect degree in ADHD group were more than the normal group. Such as neglect score of physical, emotional, educational and medical neglect subscales of ADHD group were higher than the control group, and the score of safe neglect subscale was not significant difference.
⑥the average content of S100βprotein in 6-10 year old normal school children was 42.71pg/ml, the standard deviation was 10.76 pg/ml, and with no different in sex and age.
⑦The content of serum S100βprotein in children of ADHD group was obviously lower than that of children in normal group, which had obviously positive correlation with IQ and scores of IVT-CPT. There was no remarkable difference in the content of serum S100βprotein during four subtypes.
Conclusion: The data indicated that①The unreasonable meals structure, imbalanced nutrition and body fluid acid-base equilibrium disorder of children were the causative factors of ADHD.
②There was some relation between child neglect and ADHD, especially the emotional , educational and medical neglect subscales were primary hazard factor of ADHD morbidity.
③In our data the content of serum S100βprotein in 6-10 year old normal school children can be applied in clinic.
④Compared with control group, in ADHD group, the content of serum S100βprotein was obviously lower, indicated that there was relation between S100βand ADHD, further prompted the child with ADHD was associated with the brain development immature.
引文
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2. American Psychiatric Association DSM-IV-TR. Diagnostic and statistical manual of mental disorders[M]. 4th ed. Text revision, Washington DC:American Psychiatric Press, 2001, 130(3): 78-85
3. Timothy P T. The Integrated Visual and Auditory Continuous Performance Test as a neuropsychological measure[J]. Archives of Clinical Neuropsychology, 2003, (18) :439-454
4. 黄梅, 陈文彩, 翁丽芬. 均衡膳食对学龄前儿童生长发育的影响[J].中国学校卫生杂志,2005,26(10):840-841
5. Bazar KA , Yun AJ, Lee PY ,et al. Obesity and ADHD may represent different manifestations of a common environmental oversampling syndrome: a model for revealing mechanistic overlap among cognitive, metabolic, and inflammatory disorders [J]. Medical Hypotheses, 2006, 66(2): 263-269
6. Bruce F and Marius L. Preservation of heat stress induced myocardial hsp-72 in aged animals following caloric restriction[J]. Experimental Gerontology, 2005, 40(7): 615-617
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