注意力缺陷多动障碍患儿哌甲酯治疗期间心率变异性变化的临床研究

摘要

目的 探讨心率变异性(HRV)在注意力缺陷多动障碍(ADHD)患儿哌甲酯治疗期间的变化.方法 选取2014-2015年来我院就诊的ADHD患儿80例,其中完成连续12周哌甲酯治疗36例.采用ADHD诊断量表(父母版)和持续性操作测验(CPT)评定治疗前后患儿行为;检测患儿治疗前后HRV指标,包括心率、RR间期标准差(SDNN)、相邻RR间期差的均方根(RMMSD)、总频率(TP)、高频(H-F)、低频(LF)、极低频(VLF)、交感-副交感神经功能平衡指数(LF/HF).采用Pearson相关性分析ADHD患儿行为与HRV参数的关联性.结果 治疗前,心率、HF、LF/HF与注意缺陷分呈负相关(r=-0.278、-0.229、-0.251,P=0.012、0.035、0.008);心率与量表总分呈负相关(r=-0.259,P=0.032);VLF与CPT错误数呈负相关(r=-0.239,P=0.045).治疗前后心率、RMSSD、HF比较差异有统计学意义(f=4.615、3.027、3.192,P=0.027、0.048、0.046),治疗前后心率、RMSSD、TP、LF、HF呈正相关(r=0.395、0.564、0.352、0.342、0.332,P=0.021、0.008、0.025、0.035、0.031).结论 HRV可作为ADHD治疗的心理生理标志物,用于辅助评价ADHD患儿的治疗效果.%Objective To investigate the heart rate variability (HRV) changes during methylphenidate treatment in children with attention-deficit hyperactivity disorder (ADHD).Methods Totally 80 ADHD children treated in our hospital from 2014 to 2015 were enrolled,in which 36 ADHD children received methylphenidate treatment for 12 weeks.The behavior changes were evaluated by ADHD diagnostic scale (parent version) and continuous performance test (CPT) before and after treatment.HRV,including heart rate,the standard deviation of the normal-to-normal interval (SDNN),the square root of the mean squared difference of successive normal-to-normal intervals (RMSSD),total power (TP),high frequency (HF),low frequency (LF),very low frequency (VLF) and LF/HF were also detected before and after treatment.Pearson's correlation was used to determine the correlation between ADHD clinical variables and HRV parameters.Results Negative correlation was found between the inattention score and heart rate,HF or LF/HF (r =-0.278,-0.229,-0.251;P =0.012,0.035,0.008).Negative correlation was observed between heart rate and total score (r =-0.259,P =0.032),and VLF and commission errors (r =-0.239,P =0.045).There were significant differences in heart rate,RMSSD and HF before and after treatment (t =4.615,3.027,3.192;P =0.027,0.048,0.046).Heart rate,RMSSD,TP,LF and HF had a positive correlation before and after treatment (r =0.395,0.564,0.352,0.342,0.332;P =0.021,0.008,0.025,0.035,0.031).Conclusion HRV can be used as psychophysiological markers to evaluate the efficacy of the treatment for ADHD.