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目的观察哌甲酯对不同亚型注意缺陷多动障碍(ADHD)患儿的疗效和安全性,寻找潜在的疗效影响因素及疗效预测指标。方法入组标准为符合我国《儿童注意缺陷多动障碍诊疗建议》中ADHD诊断标准的患儿,给予系统的哌甲酯剂量滴定。以父母填写的ADHD评定量表、Conners’量表和对儿童进行的持续性操作测试(CPT)作为疗效评价指标,随访观察6个月。收集潜在的疗效影响因素资料,包括就诊时症状严重程度、智商、学习成绩等。结果 1.总的疗效指标分析:父母填写的ADHD症状评定量表分、Conners’量表分、儿童进行的CPT治疗前后差值均具有统计学意义。2.各亚型疗效比较:(1)ADHD症状评定量表总分的减分率:混合型与注意障碍为主型比较差异无统计学意义;多动冲动型及混合型比较差异有统计学意义;多动冲动型与注意障碍为主型比较差异有统计学意义;(2)Conners’量表减分率:混合型、注意障碍为主型、多动冲动型比较差异无统计学意义;(3)CPT平均分的减分率:混合型、注意障碍为主型、多动冲动型比较差异无统计学意义;(4)有效率和显效率:混合型有效率68.25%,显效率55.56%;注意障碍为主型有效率75.82%,显效率56.04%;多动冲动型有效率63.64%,显效率45.45%。3.疗效影响因素:就诊时症状的严重程度和韦氏智商评分与疗效相关。结论哌甲酯治疗儿童ADHD安全有效,对混合型和注意障碍为主型的ADHD患儿的疗效可能优于多动冲动型。疗效的可能影响因素包括治疗前症状的严重程度和韦氏智商评分等。
Objective To observe the efficacy and safety of methylphenidate in children with different subtypes of Attention Deficit Hyperactivity Disorder (ADHD), and to find out the potential influential factors and predictors of therapeutic effect. Methods The inclusion criteria were pediatric methylphenidate titration in order to meet the criteria of ADHD diagnosis in “Advice on Diagnosis and Treatment of ADHD in Children”. ADHD rating scale completed by parents, Conners’ scale and continuous operation test for children (CPT) as indicators of efficacy, follow-up observation of 6 months. Collect information on potential effects, including severity of symptoms at the time of visit, IQ, academic performance, etc. Results 1. The overall efficacy index analysis: parents fill in the ADHD symptom rating scale points, Conners’ scale points, CPT children before and after treatment differences were statistically significant. 2. The subtype of efficacy comparison: (1) ADHD Symptom Rating Scale total score reduction rate: mixed and attention deficit-based comparison was no significant difference; hyperactivity impulsive and mixed-type difference was statistically significant Significance; multi-action impulsive and attention-deficit-based comparison was statistically significant; (2) Conners’ scale reduction rate: mixed, attention-deficit-based, hyperactivity impulsive differences were not statistically significant; (3) The percentage reduction of CPT average score: mixed type, attention-deficit-based type, multiple impulsive type had no statistical significance; (4) The effective rate and effective rate were 68.25%, effective rate 55.56 %; Attention disorder-based efficiency of 75.82%, markedly effective rate of 56.04%; multiple impulsive type of effective rate 63.64%, markedly efficient 45.45%. 3. Efficacy factors: the severity of symptoms at the time of treatment and Webster’s IQ score related to efficacy. Conclusion Methylphenidate is safe and effective in the treatment of ADHD in children, and its efficacy is better than that of hyperactivity-impulsive type in children with mixed and attention-deficient ADHD. Possible effects of treatment include the severity of pretreatment symptoms and Webster’s IQ score.