注意缺陷多动障碍儿童唾液与血浆皮质醇水平变化及临床意义

目的 研究注意缺陷多动障碍(ADHD)儿童的唾液皮质醇及血浆皮质醇的分泌水平,探讨ADHD患儿下丘脑-垂体-肾上腺(HPA)轴的功能改变及临床意义. 方法 ADHD男性儿童143例,临床诊断和分型均符合DSM-ⅣADHD的临床诊断和分型标准;对照组为年龄匹配的健康男童47名.于7:50空腹状态下收集应激前唾液标本,8:00静脉采血作为应激源,采血后再次收集唾液标本.分别采用全自动微粒子化学发光法检测血浆皮质醇,酶联免疫吸附法检测唾液皮质醇.所有儿童均采集到血液标本;唾液标本采集情况:ADHD组应激前23例,应激后18例;对照组应激前16例,应激后14例. 结果 (1)血浆皮质醇:ADHD组为(236.72士106.76)nmol/L(71.31～707.41 nmol/L),对照组为(351.84士133.26)nmol/L(141.31～530.67 nmol/L),2组比较差别有统计学意义(P＜0.01).(2)唾液皮质醇:应激前ADHD组为(341.43±39.63)ng/mL(270.32～401.72 ng/mL),对照组为(362.24±39.32) ng/mL(284.12～420.42 ng/mL);应激后ADHD组为(364.82±30.10) ng/mL(324.0～415.0 ng/mL),低于对照组(394.99±31.30)ng/mL(347.67～431.35 ng/mL);而对照组应激后较应激前升高. 结论 ADHD儿童存在HPA轴调节功能障碍,表现为应激后皮质醇低反应性;通过检测患儿的血浆基础皮质醇来反映其HPA轴的功能是一种较为便捷、实用的方法.

The Clinical Significance of Cortisol Levels in Children withAttention Deficit Hyperactivity Disorder

Objective To explore the function of hypothalamic-pituitary-adrenal (HPA) axis and its clinical significance in children with attention hyperactivity disorder (ADHD) by evaluating the level of salivary cortisol and plasma cortisol.Methods 143 male children with ADHD,6 to 14 years old,were included in this study.The diagnosis of ADHD and its three subtypes were made based on the criteria cited by the handbook for the diagnosis and treatment of ADHD by American Psychiatry Association (DSM-Ⅳ).Meanwhile,47 healthy male children,6 to 14 years old,were in the control group.We collected the fasting saliva at 7:50 am.Then the venipuncture was adopted as a stressor.Venous blood 5 mL were collected at 8:00 am and the fasting saliva were collected again after venipuncture.The levels of plasma cortisol were evaluated by automatic particle enzyme immunoassay,and the levels of salivary cortisol were evaluated by enzyme-linked immunosorbent assay.From all children in the two groups the blood samples were collected.There were 23 cases with saliva samples before stress,18 cases after stress in ADHD group.There were 16 cases with saliva samples before stress,14 cases after stress in control group.Rusults The level of basic plasma cortisol in ADHD group (236.72±106.76) nmol/L] was significantly lower than that in the control group (351.84±133.26) nmol/L](P＜0.01).The level of salivary cortisol in ADHD group before stress (341.43 ± 39.63)ng/mL] compared to the control group (362.24±39.32)ng/mL] showed no significant difference(P＞0.05).The level of salivary cortisol in control group after stress was significantly higher than it was before stress(P＜0.05).But the level of salivary cortisol in ADHD group after stress (364.82±30.10)ng/mL] was significantly lower than that in the control group after stress (394.99 ± 31.30) ng/mL] (P ＜ 0.05).Conclusions Children with ADHD exhibits dysfunction in HPA,which may showhyporesponsivenessin cortisol level after stress.It is often difficult to collect saliva sample than to collect blood sample in children.The plasma basal cortisol detection is recommended as aconvenient and practical method to reflect HPA axis function.