经哌醋甲酯系统治疗有效的儿童注意缺陷多动障碍患者停药后静息态fMRI变化的研究

发布时间：2018-04-30 05:02

本文选题：注意缺陷多动障碍 + 静息态功能核磁共振　；参考：《昆明医科大学》2017年硕士论文

【摘要】：[目的]探索经系统哌醋甲酯治疗的注意缺陷多动障碍(Attention Deficit Hyperactivity Disorder,ADHD)患者在停药6-8周后静息态功能磁共振成像(Resting State Functional Magnetic Resonance Imaging,RS-fMRII)、认知功能及临床症状的变化情况及其影响因素,从而为临床制定个体化治疗方案、特别是选择停药时机提供参考。[方法]收集13例经哌醋甲酯系统治疗8周以上、治疗有效、且符合DSM-Ⅳ诊断标准的ADHD患儿(服药有效组)、以及12例与服药有效组年龄、性别、智商、临床症状严重程度相匹配的未服药ADHD患者(未服药对照组)的临床资料,包括一般情况、临床症状表现、认知功能等。采用ADHD症状分级父母评量表(Attention Deficit Hyperactivity Disorder Rating Scale-IV Home Version, ARS)及 Conners 父母评症状量表(Conners Parent Symptom Questionnaire, PSQ)评估患者的临房床症状,采用注意力持续操作测验、Rey复杂图形、连线实验、Stroop色词干扰测试等工具评估患者的认知功能。采用飞利浦3. 0T磁共振机器采集未服药对照组患者、服药有效组患者服药期及停药期的RS-fMRI脑功能数据。所有核磁数据应用基于Matlab平台下的DPARSF、REST等软件进行数据处理及统计分析。采用局部一致性(Regional Homogeneity, ReHo)、功能连接的分析方法比较各个对比组间静息态脑功能的情况,功能连接的感兴趣区(Region of Interest,ROI)选取ReHo结果中团块最大的脑区右侧前扣带和旁扣带脑回。将蒙特利尔神经病学研究所(Montreal Neurological Institute,M I)标准三维脑模板叠加到所得到的全脑统计参数图进行显示,对照AAL分区(Anatomical Automatic Labeling, AAL)标记出具有统计学差异的团块所包含脑区及脑区的体素大小,并且记录这些团块的峰值坐标及峰值强度。采用配对T检验统计方法,比较9例服药有效组患者服药期与停药期临床症状、认知功能及脑功能的变化;比较12对未服药对照组与服药有效组服药期临床症状、认知功能及脑功能的差异;比较8对未服药对照组与服药有效组停药期临床症状、认知功能及脑功能的差异。[结果]1、服药有效组共13人完成服药期临床资料及静息态脑功能数据收集,其中男12人(92. 3%),女1人(7. 7%)。年龄最大13岁(2人),最小8岁(3人),平均年龄9. 77±1.69岁。IQ最高为106 (1人),最低为85 (1人),平均IQ94. 54±6. 06。其中9人完成停药期的临床资料及静息态脑功能数据收集;纳入与服药有效组性别(同性别)、年龄(相差≤1岁)、IQ (相差≤15)、体重(相差≤5Kg)相匹配的ADHD患儿共12人;2、服药有效组的ADHD患儿(n=9)停药后ARS及PSQ总分上升(P均0. 05) ,其中高龄组(9岁)的ADHD患儿ADHD症状评估量表的增分较低龄组(≤9岁)的患儿低(P0. 05);服药有效组的ADHD患儿停药后在左侧眶部额下回、左侧眶部额中回、右侧前扣带和旁扣带脑回、右侧的背外侧额上回、右侧内侧额上回等脑区ReHo值变低,而在小脑脑区的ReHo值升高(P均0. 05);以右侧前扣带和旁扣带脑回作为ROI,服药有效组停药后与ROI连接强度降低的脑区有左右侧的眶部额上回及左侧眶部额下回,与ROI连接强度增强的脑区有左右侧的顶上回、右侧颞中回、枕中回及小脑(P均0.05);3、与未服药对照组相比,服药有效组服药期(12对)PSQ总分、ARS总分、注意缺陷因子分、CPT错误数T值均较低(P均0.05);服药有效组服药期在左侧内侧额上回、右侧前扣带和旁扣带脑回等脑区较未服药对照组ReHo值高,在右侧顶上回脑区较未服药对照组ReHo值低(P均0. 05);4、与未服药对照组相比,服药有效组停药期(8对)PSQ总分低、Rey复杂图形等级及Stroop色词得分等级高(P均0.05);服药有效组停药期在左侧额中回较未服药对照组ReHo值高,而在小脑较未服药对照组ReHo值低(P均0. 05)。[结论]经哌醋甲酯系统治疗有效的ADHD患者在停药后临床症状及静息态脑功能均会出现不同程度的加重或衰退,率先出现衰退的脑区集中在前额叶及前扣带回。但即便如此,停药期患儿的临床表现、认知功能及脑功能依然要优于未服药患者;本研究仅发现患者的年龄是停药后临床症状加重程度的影响因素,年龄9岁的ADHD患儿临床症状的加重程度较年龄≤9岁的患儿轻。
[Abstract]:[Objective] to explore the changes of the resting state functional magnetic resonance imaging (Resting State Functional Magnetic Resonance Imaging, RS-fMRII) in patients with Attention Deficit Hyperactivity Disorder (ADHD) after 6-8 weeks of drug withdrawal, and the changes in the cognitive energy and clinical symptoms and the influencing factors. In order to establish an individualized treatment plan for clinical treatment, especially to choose the time of withdrawal, 13 cases of ADHD, which were treated effectively, were treated effectively, and were in line with DSM- IV diagnostic criteria (effective group), and 12 cases were matched with the age, sex, IQ, and clinical symptom severity of the effective group. Clinical data of patients with drug ADHD (untreated control group), including general conditions, clinical symptoms, cognitive functions, and so on. Using the ADHD symptom graded parents Rating Scale (Attention Deficit Hyperactivity Disorder Rating Scale-IV Home Version, ARS) and Conners parents rating scale Patients with atrial bed symptoms, using attention continuous operation test, Rey complex graph, connection test, Stroop color word interference test and other tools to evaluate the patient's cognitive function. Using PHILPS 3. 0T MRI machine to collect the patients in the control group, the effective group of patients in the period of taking medicine and the time of RS-fMRI brain function data. Data processing and statistical analysis are carried out based on DPARSF and REST software based on Matlab platform. Local consistency (Regional Homogeneity, ReHo), functional connection analysis method is used to compare the rest state brain function of each contrast group, and the region of interest of functional connection (Region of Interest, ROI) selects the largest mass in the ReHo result. The right anterior cingulate and paracerebral gyrus in the brain area. The Montreal Neurological Institute (M I) standard three-dimensional brain template was superimposed on the obtained statistical parameters of the whole brain, and the AAL partition (Anatomical Automatic Labeling, AAL) was used to mark the brain regions with statistical differences. And the size of voxel in the brain area and the peak value and peak intensity of these groups were recorded. The clinical symptoms, cognitive function and brain function of the 9 patients in the effective group were compared with the changes of the clinical symptoms, cognitive function and brain function of the 9 cases, compared with the 12 pairs of untreated control group and the effective group, and the cognitive function and brain. The difference in function, compared the clinical symptoms, cognitive function and brain function of the 8 untreated control group and the effective group, [results]1, 13 people in the effective group completed the clinical data and the resting state brain function data collection, including 12 men (92.3%), 1 women (7.7%), the oldest 13 years (2), and the smallest 8 years old (3), averages) The highest.IQ was 9.77 + 1.69 years old (1 people), the lowest was 85 (1), and the average IQ94. 54 + 6. 6 of them had completed the clinical data and the resting state brain function data collection in the stopping drug period; it was included in the ADHD children with the gender (the same sex), the age (the difference < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < < 9.77); a total of ADHD children who were matched with IQ (difference < < < < < < < < 5Kg). The total score of ARS and PSQ in the effective group of ADHD children (n=9) increased (P 0.05). The increase score of the ADHD symptom assessment scale for ADHD children in the elderly group (9 years old) was lower (P0. 05) than those in the lower age group (< < 9 years of age); the effective group of ADHD children in the effective group stopped at the left orbital frontal gyrus, the left orbital frontal gyrus, right anterior cingulate and paracasal cingulate gyrus, right The ReHo value of the lateral frontal lateral frontal gyrus and the right medial upper frontal gyrus was lower, while the ReHo value in the cerebellar brain region increased (P 0.05), and the right anterior cingulate and paracerebral cingulate gyrus were used as ROI. The brain area of the effective group with the decrease of the intensity of the ROI connection had the left and right orbital frontal gyrus and the left orbital frontal gyrus, and the strength of the ROI connection was enhanced. The brain area had the upper and right lateral parietal gyrus, right temporal gyrus, occipital gyrus and cerebellum (P 0.05); 3, compared with the untreated control group, the effective group (12 pairs) of PSQ total, ARS total, attention deficit factor, and CPT error number T were lower (P 0.05); the effective group took the drug group in the left medial frontal gyrus, right anterior cingulate and paracerebral cingulate. Compared with those in the untreated control group, the value of ReHo was higher than that in the non drug control group (P 0.05) in the right top upper upper gyrus, and 4, 4. Compared with the untreated control group, the total score of PSQ in the effective group was lower than that in the control group (8 pairs), and the Rey complex figure grade and the Stroop color word score were higher (P 0.05), and the effective group was not given the left middle frontal gyrus in the effective group. The ReHo value of the drug control group was high, but the ReHo value of the cerebellum was lower than that in the control group (P 0.05). [Conclusion] the clinical symptoms and the resting state brain function of the effective ADHD patients treated with methylphenidate system were aggravated or declined in varying degrees after the withdrawal of the drug, and the first occurrence of the recession was concentrated in the prefrontal and anterior cingulate gyrus, but even so, The clinical manifestation, cognitive function and brain function of the children in the drug stop period are still better than those in the untreated patients. This study only found that the age of the patients was the influencing factor of the severity of the clinical symptoms after the drug withdrawal, and the severity of the clinical symptoms of ADHD children aged 9 years was lighter than those aged 9 years old.

【学位授予单位】：昆明医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.94

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