注意力缺陷多动障碍儿童下丘脑-垂体-肾上腺轴的功能研究

目的：通过研究注意力缺陷多动障碍（ADHD）儿童下丘脑-垂体-肾上腺轴（HPA）的功能状态，探讨HPA轴在ADHD发生中的作用。方法：128例6～14岁ADHD男童根据DSM-IV ADHD诊断和分型标准，其中注意缺陷为主型(ADHD-I)44例，多动-冲动为主型(ADHD-HI)32例，混合型(ADHD-C)52例，对照组为年龄匹配健康男童30名，于8∶00 am空腹采血。分别采用全自动微粒酶免疫分析法及电化学发光法检测血浆皮质醇及促肾上腺皮质激素（ACTH），智力测验采用瑞文标准推理测验。结果：ADHD组IQ(84.5±11.3)低于对照组(94.6±12.4，P<0.01)，ADHD 3个亚型组间比较差异有显著性(P<0.01)，ADHD-I 和ADHD-C 两个亚组IQ水低于对照组(P<0.01), ADHD-HI组与对照组比较差异无显著性。ADHD组血浆皮质醇水平 (226.5±129.1 nmol/L)较对照组(384.5±141.4 nmol/L)明显降低(P<0.01)，ADHD-HI组(154.4±71.6 nmol/L)下降程度较ADHD-I组(219.4±117.7 nmol/L)及ADHD-C组(258.3±136.4 nmol/L)为著(P<0.01)，而ADHD各组血浆ACTH水平与对照组比较差异无显著性。结论：在非应激状态下ADHD儿童存在着HPA轴调节功能障碍，这可能系HPA轴低反应性所致。低血浆皮质醇对认知行为影响较小，而与注意缺陷、多动、冲动行为关系更为密切。［中国当代儿科杂志，2009，11（12）：992-995］

Function of the hypothalamus-pituitary-adrenal axis in children with attention deficit hyperactivity disorder

Objective To study the function of the hypothalamus-pituitary-adrenal (HPA) axis in children with attention deficit hyperactivity disorder (ADHD). Methods One hundred and twenty-eight boys with ADHD at ages of 6 to 14 years were enrolled. The diagnosis and grouping of ADHD were based on the Diagnostic and Statistical Manual of Mental Disorders ( DSM-IV) : ADHD-predominantly inattention type (ADHD-I, n =44), ADHD-predominantly hyperactive impulsivetype (ADHD-HI, n = 32) and ADHD-combined type (ADHD-C, n =52). Thirty healthy boys served as the control group. Plasma levels of cortisol and adrenocorticotropic hormone ( ACTH) were measured by automatic particle enzyme immunoassay and electrochemiluminescence respectively at 8:00 am. The intelligence level was tested by Raven's standard progressive matrices. Results The children with ADHD had lower IQ score (84.5 ±11.3) than the control group (94.6 ± 12. 4) (P < 0. 01 ). There were significant differences in the IQ score among the three ADHD subgroups (P <0.01). The IQ score in the ADHD-I and the ADHD-C groups was significantly lower than that in the control group. The mean plasma cortisol level in the ADHD group (226. 5 ± 129. 1 nmol/L) was significantly lower than that in the control group (384.5 ±141.4 nmol/L) (P<0.01). The three ADHD subgroups showed significantly decreased plasma cortisol level compared with the control group ( P < 0. 01). The plasma level of cortisol was the lowest in the ADHD-HI group (154.4 ± 71. 6 nmol/L), Mowed by the ADHD-I group (219. 4 ± 117. 7 nmol/L) and the ADHD-C group (258.3 ±136.4 nmol/L). There were no significant differences in plasma concentration of ACTH between ADHD and control children. Conclusions In the non-stress state, the HPA axis may be dysfunctional in children with ADHD, which may be attributed to the under reactivity of the HPA axis. Lower plasma cortisol has fewer impacts on the cognitive-behavior function, but it may closely be related to attention deficit, hyperactivity and impulsive behaviors.