摘要
目的:探讨盐酸托莫西汀联合维生素D治疗儿童注意缺陷多动障碍(ADHD)合并情绪障碍的临床效果。方法:选取2024年6月至2025年8月收治的80例ADHD合并情绪障碍患儿,分为联合组(40例)和单一组(40例)。单一组给予盐酸托莫西汀胶囊口服治疗,联合组在单一组基础上补充维生素D制剂,两组疗程均为12周。比较两组临床疗效,治疗前后核心症状指标,血清神经生化指标,神经电生理指标。结果:治疗12周后,联合组的显效率及总有效率均显著高于单一组(P<0.05);治疗后,两组斯诺佩评定量表第四版(SNAP-IV)、儿童抑郁量表(CDI)及儿童焦虑量表(CAS)评分下降,联合组下降幅度大于单一组(P<0.05)。在认知功能方面,两组的工作记忆指数与工作加工速度指数治疗后均有所提升,且联合组的改善程度显著优于单一组(P<0.05);治疗后,两组血清脑源性神经营养因子(BDNF)、胶质细胞源性神经营养因子(GDNF)、5-羟色胺(5-HT)及多巴胺(DA)水平较治疗前显著升高,且联合组升幅大于单一组(P<0.05);联合组血清S100钙结合蛋白B(S100B)水平较治疗前降低,且降幅大于单一组(P<0.05)。单一组仅GDNF水平治疗前后变化不显著(P>0.05);治疗后,两组θ/β功率比值显著下降,事件相关电位(ERP)P300潜伏期显著缩短、波幅显著升高,且联合组改善幅度均显著优于单一组(P<0.05)。结论:盐酸托莫西汀联合维生素D治疗可显著提升ADHD合并情绪障碍患儿的临床总有效率,并能协同改善其核心注意缺陷多动症状、焦虑抑郁情绪及工作记忆等认知功能,疗效显著。其机制可能与联合方案更有效地调节血清神经营养因子、神经递质水平,降低神经损伤标志物,并优化脑电生理活动相关。
Objective:To investigate the clinical efficacy of the combination of atomoxetine hydrochloride and vitamin D in the treatment of children with Attention Deficit HyperactivityDisorder(ADHD)complicated with mood disorders.Method:80 children with ADHD and emotional disorders admitted from June 2024 to August 2025 were selected and randomly divided into a combination group(40 cases)and a single group(40 cases).The single group was given oral treatment with atomoxetine hydrochloride capsules,while the combination group was supplemented with vitamin D supplements on the basis of the single group.Both groups received a treatment course of 12 weeks.Compare the clinical efficacy,core symptom indicators before and Post-treatment,serum neurobiochemical indicators,and neurophysiological indicators between two groups.Result:After 12 weeks of treatment,the significant and total effective rates of the combination group were higher than single group(P<0.05);Post-treatment,the scores of Swanson,Nolan,and Pelham,Version IV(SNAP-IV),Children's Depression Inventory(CDI),and Childhood Anxiety Scale(CAS)in both groups significantly decreased compared to pretherapy(P<0.05),and the decrease in the combination group was greater than that in the single group(p<0.05).In terms of cognitive function,both groups showed improvement in working memory index and processing speed index Post-treatment,and the improvement in the combination group was significantly better than that in the single group(P<0.05);Post-treatment,the serum levels of Brain Derived Neurotrophic Factor(BDNF),Glial Cell Line Derived Neurotrophic Factor(GDNF),5-hydroxytryptamine(5-HT),and dopamine(DA)in both groups significantly increased compared to pretherapy,and the increase in the combination group was greater than that in the single group(P<0.05);The serum level of S100 calcium binding protein B(S100B)in the combined group was reduced compared to pretherapy,and the decrease was greater than that in the single group(p<0.05).The single group showed no change in GDNF levels before and Post-treatment(P>0.05);Post-treatment,the power ratio ofθ/βin both groups significantly decreased,and the latency of Event Related Potential(ERP)P300 was shortened and the amplitude was increased.The improvement in the combination group was better than that in the single group(P<0.05).Conclusion:The combination of atomoxetine hydrochloride and vitamin D treatment can significantly improve the overall clinical efficacy of children with ADHD and mood disorders,and can synergistically improve their cognitive functions such as core attention deficit hyperactivity disorder symptoms,anxiety and depression,and working memory,with significant therapeutic effects.The mechanism may be related to the more effective regulation of serum neurotrophic factor and neurotransmitter levels,the reduction of nerve damage markers,and the optimization of brain electrophysiological activity by the combined regimen.
作者
王婷婷
张敏
童画
潘华宝
于锦
陈树霞
WANG Ting-ting;ZHANG Min;TONG Hua;PAN Hua-bao;YU Jin;CHEN Shu-xia(Department of Pharmacy,Yancheng First Hospital Affiliated of Nanjing University Medical College/Yancheng NO.1 People's Hospital,Yancheng,Jiangsu,224006,China)
出处
《现代生物医学进展》
2026年第5期793-800,共8页
Progress in Modern Biomedicine
基金
江苏省药学会—奥赛康医院药学科研基金课题(A202438)。
关键词
注意缺陷多动障碍
情绪障碍
盐酸托莫西汀
维生素D
儿童
联合治疗
Attention Deficit Hyperactivity Disorder
Emotional disorders
Atomoxetine hydrochloride
Vitamin D
Children
Combination therapy
