儿童支气管哮喘相关死亡的现状与危险因素

支气管哮喘(简称哮喘)是最常见的儿童呼吸系统慢性疾病。随着吸入性糖皮质激素使用的增加,全球哮喘死亡下降了近2/3。在世界范围内,儿童哮喘死亡率非常低,为0~0.7/10万,但大多数的死亡仍存在可能避免的危险因素。哮喘死亡的危险因素包括哮喘控制不良、治疗依从性差、医师处方的药量不足、肺功能监测不足、精神心理问题以及存在有食物过敏、哮喘急性发作的识别及处理不足、β2受体激动剂使用不当以及哮喘行动计划应用不足等。现就儿童哮喘死亡现状及其危险因素进行阐述,为进一步改善哮喘管理策略提供依据。     

儿童注意缺陷多动障碍常见神经内科共患病及治疗北大核心CSCD

儿童注意缺陷多动障碍(ADHD)是一种儿童时期常见的神经发育障碍性疾病,虽然ADHD的病因很多,但继发于小儿神经系统疾病后ADHD其实并不少见,其正规诊断与治疗尤为重要。该文从脑结构异常、小儿神经科疾病与ADHD入手,对癫痫、头痛、睡眠障碍及脑炎与ADHD之间相互关系进行讨论。旨在强调ADHD的早期诊治和干预固然重要,其病因诊断与鉴别诊断不能忽略,标本兼治十分重要。     

儿童变应性鼻炎与注意缺陷多动障碍相关性研究进展

近年来国内外学者逐渐认识到儿童变应性鼻炎(allergic rhinitis,AR)与注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)之间具有一定相关性。AR患儿较正常儿童有更高的ADHD相关症状评分;ADHD儿童出现过敏性疾病,如哮喘、湿疹和特应性皮炎的风...     

儿童血清过敏原与哮喘发生关系的探讨

目的探讨儿童血清特异性Ig E(s Ig E)过敏原与哮喘发生的关系。方法采用免疫印迹法对2004年12月至2013年4月就诊的2 239例1~14岁单纯哮喘患儿(n=1 415)和非过敏性疾病患儿(n=824)的血清s Ig E过敏原进行检测,分别建立所有样本、不同年龄及不同性别单纯哮喘与非过敏性疾病的病例对照模型,采用多因素logistic回归分析探讨过敏原与哮喘发生的关系。结果 2 239例患儿中,血清s Ig E阳性者1 028例(45.91%),过敏原阳性率居于前三位的为户尘螨(15.68%)、屋尘(14.29%)和霉菌类(13.40%)。病例对照研究结果显示,户尘螨、霉菌类、屋尘、腰果/花生/黄豆是哮喘发病的危险因素(P0.05);不同年龄组与哮喘发生相关的过敏原有所不同,1岁~组儿童仅屋尘与哮喘的发生有关,户尘螨和屋尘是3~14岁儿童哮喘发生的危险因素,而霉菌类是6~14岁儿童哮喘发生的危险因素(P0.05);户尘螨和屋尘是男、女儿童哮喘发生的危险因素(P0.05),而腰果/花生/黄豆和霉菌类仅是男性儿童哮喘发生的危险因素(P0.05)。结论户尘螨、屋尘、霉菌类为哮喘患儿最常见过敏原,且与哮喘发生关系极为密切。     

儿童鼻-鼻窦炎及其对支气管哮喘的影响

鼻-鼻窦炎和支气管哮喘（简称哮喘）是上呼吸道和下呼吸道的慢性炎症性疾病,二者之间存在着密切的关系,被称为联合气道疾病。鼻-鼻窦炎是哮喘新发和控制不佳的危险因素。对于联合气道疾病,治疗鼻-鼻窦炎及综合管理对哮喘患者来说至关重要。该文就儿童鼻-鼻窦炎及其对哮喘的影响及治疗方案作一述评,为联合气道疾病的诊疗及管理提供一定的参考。     

儿童注意缺陷多动障碍家庭危险因素的Meta 分析

目的 综合分析儿童注意缺陷多动障碍(ADHD)家庭危险因素,为今后防治工作提供依据。方法 系统收集2000~2014 年涉及中国儿童ADHD 发病危险因素的病例对照文献,从中提取家庭因素有关数据;按照NOS 标准对纳入文献进行质量评价;采用Stata 12.0 软件对纳入文献进行Meta 分析。结果 最终纳入16 篇文献,包括ADHD 病例2 167 例,对照2 148 例。Meta 分析显示,良好的教养方式(OR=0.32,95%CI:0.26~0.40)、核心家庭(OR=0.56,95%CI:0.41~0.76)、父亲文化程度高(OR=0.56,95%CI:0.41~0.76)、母亲文化程度高(OR=0.65,95%CI:0.47~0.89)、母亲性格外向(OR=0.33,95%CI:0.18~0.61)是儿童ADHD 的保护因素;父母关系差(OR=1.90,95%CI:1.17~3.06)和ADHD 家族史(OR=5.86,95%CI:3.67~9.35)是ADHD 的危险因素。结论 良好的教养方式、核心家庭类型、父母文化程度高以及母亲性格外向可降低儿童ADHD 的发病风险,而父母关系差、ADHD 家族史可增加ADHD 患病的风险。     

多不饱和脂肪酸与注意缺陷多动障碍

注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)是儿童青少年期常见的心理行为障碍,其主要临床特征为注意力不集中、活动过度和行为冲动.ADHD的发病机制及病因至今不明,多数学者认同ADHD是生物-心理-社会因素共同作用形成的疾病模型.生物学因素包括生物化学、遗传学、免疫学、神经系统发育障碍、脑电生理、影像学等.近年来,人体营养状况与精神心理健康的关系愈来愈引起研究人员注意,也不断有学者报道儿童青少年营养状况与ADHD存在一定的相关性,其中多见多不饱和脂肪酸(polyunsaturated fatty acid,PUFA)与ADHD关系的研究,以及锌元素、镁元素在脂肪酸(fatty acid)与ADHD中的作用.本文在查阅相关文献基础上,仅就此方面做一综述.     

深圳市7～14岁儿童注意缺陷多动障碍影响因素分析

目的探讨深圳市7～14岁学龄儿童注意缺陷多动障碍(ADHD)的患病情况及影响因素,为早期干预与治疗提供依据。方法采用Conners教师评定量表(TRS)对深圳市7～14岁在校学龄儿童进行分层随机抽样调查,对经TRS初步筛查为阳性的儿童进行小儿神经专科门诊随访,排除严重躯体疾病、神经系统疾病和其他精神疾病,根据美国精神病学会的精神障碍诊断和统计手册第4版诊断ADHD,统计分析家长填写的ADHD影响因素调查表,完成ADHD影响因素调查。采用SPSS 13.0软件进行统计学分析。结果深圳市7～14岁儿童ADHD总患病率为5.40%(442/8 193),其中男性高于女性,7～9岁年龄组儿童患病率最高,随年龄增长有下降趋势。出生窒息史、挑食/偏食习惯、右手或左手的习惯、每天看电视时间、同学之间关系是ADHD的重要影响因素。结论深圳市学龄儿童ADHD患病率与国内外其他调查相近,ADHD受多种因素共同影响,家长、教师及医师应共同合作,重视早期针对性干预与治疗。     

呼吸道合胞病毒诱发哮喘的机制

呼吸道合胞病毒 (RSV)是两岁以内儿童呼吸道疾病的常见病原 ,它与哮喘的关系一直是学术界关注的焦点。RSV感染婴幼儿后可通过多种机制引起哮喘发作。该文主要对RSV感染后引起哮喘的免疫学机制、神经机制及神经免疫机制进行综述     

注意缺陷多动障碍早期识别、规范诊断和治疗的儿科专家共识

注意缺陷多动障碍(ADHD)是一种常见的慢性神经发育障碍,起病于童年期,影响可延续至成年,可共病多种神经精神障碍。早期识别、诊断和规范治疗对ADHD的预后有重要作用。但我国儿童精神和发育行为专科医师人数不足、社会防治系统不完善,基层儿科和儿童保健科医师对ADHD尚存在早期识别不够、诊治不规范等情况。本共识旨在为儿童保健医师、全科医师和发育行为儿科医师早期识别、评估、诊断及治疗ADHD的规范化和同质性提供帮助。     

Exanthematic diseases during pregnancy and attention-deficit/hyperactivity disorder (ADHD).

Rash causing viral diseases may be transmitted during pregnancy, causing severe congenital disease. Although neurological and psychiatric disorders are common consequences of congenital rubella, children born to women who developed a viral rash during pregnancy do not appear to be at increased risk of these disorders if they were asymptomatic at birth. In a case-control study conducted to evaluate risk factors for ADHD, we found an increased risk of this disorder among children born to women experiencing a viral rash during pregnancy. The viral rash (i.e. measles, varicella, or rubella) was reported by 4 of 71 mothers of children with ADHD and none of the 118 controls' mothers (P<0.01). The difference remained statistically significant after adjusting for potential confounders (i.e. other factors found associated with ADHD, such as gender and familiarity). Although, the viral disease reported by the mothers, in accordance with their physician's diagnosis, did not represent a homogeneous nosological group, the unexpectedly high rate found among ADHD cases' mothers suggest a role for viral diseases occurring during pregnancy in the development of ADHD.     

Environmental risk factors for attention-deficit hyperactivity disorder

Attention-deficit hyperactivity disorder (ADHD) is the most common cognitive and behavioural disorder diagnosed among school children. It is characterized by deficient attention and problem solving, along with hyperactivity and difficulty withholding incorrect responses. This highly prevalent disorder is estimated to affect 5-10% of children and in many cases, persists into adulthood, leading to 4% prevalence among adults. Converging evidence from epidemiologic, neuropsychology, neuroimaging, genetic and treatment studies shows that ADHD is a valid medical disorder. The majority of studies performed to assess genetic risk factors in ADHD have supported a strong familial nature of this disorder. Family studies have identified a 2- to 8-fold increase in the risk for ADHD in parents and siblings of children with ADHD. Various twin and adoption studies have also highlighted the highly genetic nature of ADHD. In fact the mean heritability of ADHD was shown to be 0.77, which is comparable to other neuropsychiatric disorders such as schizophrenia or bipolar disorder. However, several biological and environmental factors have also been proposed as risk factors for ADHD, including food additives/diet, lead contamination, cigarette and alcohol exposure, maternal smoking during pregnancy, and low birth weight. Many recent studies have specifically examined the relationships between ADHD and these extraneous factors. This review describes some of these possible risk factors. CONCLUSION: Although a substantial fraction of the aetiology of ADHD is due to genes, the studies reviewed in this article show that many environmental risk factors and potential gene-environment interactions also increase the risk for the disorder.     

The co-occurrence of autism spectrum disorder and attention-deficit/hyperactivity disorder symptoms in parents of children with ASD or ASD with ADHD

Background: Autism spectrum disorder (ASD) and attention‐deficit/hyperactivity disorder (ADHD) share about 50–72% of their genetic factors, which is the most likely explanation for their frequent co‐occurrence within the same patient or family. An additional or alternative explanation for the co‐occurrence may be (cross‐)assortative mating, e.g., the tendency to choose a partner that is similar or dissimilar to oneself. Another issue is that of parent‐of‐origin effect which refers to the possibility of parents differing in the relative quantity of risk factors they transmit to the offspring. The current study sets out to examine (cross‐)assortative mating and (cross‐)parent‐of‐origin effects of ASD and ADHD in parents of children with either ASD or ASD with ADHD diagnosis. Methods: In total, 121 families were recruited in an ongoing autism‐ADHD family genetics project. Participating families consisted of parents and at least one child aged between 2 and 20 years, with either autistic disorder, Asperger disorder or PDD‐NOS, and one or more biological siblings. All children and parents were carefully screened for the presence of ASD and ADHD. Results: No correlations were found between maternal and paternal ASD and ADHD symptoms. Parental ASD and ADHD symptoms were predictive for similar symptoms in the offspring, but with maternal hyperactive‐impulsive symptoms, but not paternal symptoms, predicting similar symptoms in daughters. ASD pathology in the parents was not predictive for ADHD pathology in the offspring, but mother’s ADHD pathology was predictive for offspring ASD pathology even when corrected for maternal ASD pathology. Conclusions: Cross‐assortative mating for ASD and ADHD does not form an explanation for the frequent co‐occurrence of these disorders within families. Given that parental ADHD is predictive of offspring’ ASD but not vice versa, risk factors underlying ASD may overlap to a larger degree with risk factors underlying ADHD than vice versa. However, future research is needed to clarify this issue.     

Bullying among children with autism and the influence of comorbidity with ADHD: a population-based study.

OBJECTIVE: Bullying is a significant problem among school-age children. The prevalence and predictors of bullying among children with autism are not known. The objectives of this population-based study were to: (1) estimate the prevalence of bullying among children with autism in the United States, (2) determine whether the presence of attention-deficit/hyperactivity disorder/attention-deficit disorder (ADHD/ADD) increases prevalence of bullying among children with autism, and (3) determine risk factors of bullying behavior among children with autism. METHODS: The National Survey of Children's Health, 2003 (NSCH), provided nationally representative data for children ages 4 to 17. We used multivariate logistic regression and Wald tests to determine whether children with autism were more likely to bully in the presence of ADHD/ADD. Taylor approximations were used to account for the complex sampling design. RESULTS: Children with autism had a high prevalence of bullying (44%, 95% confidence interval, 34-55). Parent report of ADHD/ADD appears to moderate the relationship between bullying and autism. Children with autism who did not have ADHD/ADD were not at greater risk for bullying compared with the general population. Children with autism and ADHD/ADD had increased odds of bullying (odds ratio 4.6, 95% confidence interval 2.4-8.6), even after controlling for household income, age, and gender. In addition to ADHD/ADD, living in a low-income household and younger age were risk factors for bullying among children with autism. Being female, however, did not decrease the risk of bullying in the autistic subpopulation. CONCLUSIONS: Children with autism and ADHD/ADD appear to be at increased risk for bullying behaviors.     

ADHD as a (non) allergic hypersensitivity disorder: A hypothesis

Research data concerning the causal association between attention deficit hyperactivity disorder (ADHD) and allergies are conflicting. Allergic disorders, like asthma and eczema are clinical syndromes in which both genetic predisposition and environmental factors (pets, pollen and foods) contribute to its development. The hypothesis of ADHD, in some children also being an allergic disorder, is postulated based on comparison of the mechanisms underlying the development of ADHD and allergic disorders. According to the accepted terminology, ADHD may comply with the criteria of hypersensitivity, allergy and atopy. This hypothesis has to be thoroughly tested by randomized controlled trials using environmental triggers and immunologic research. As genes related to the immune system may be associated with ADHD, further genetic research is compulsory. Immunotherapeutic approaches, using immunotherapy and probiotics, can subsequently be implicated in the treatment of ADHD. If hypersensitivity to environmental stimuli like foods contributes to the development of ADHD, the assessment and treatment of ADHD will have to be reconsidered, thereby improving the quality of care for these patients.     

Sleep patterns in children with attention-deficit/hyperactivity disorder, tic disorder, and comorbidity

BACKGROUND: In children, attention-deficit/hyperactivity disorder (ADHD), tic disorder (TD), and their coexistence (ADHD + TD comorbidity) are very common and clinically important. Associated sleep patterns and their clinical role are still insufficiently investigated. This study aimed at characterizing these sleep patterns in children with ADHD, TD, and ADHD + TD comorbidity and determining whether, in ADHD + TD, the factors ADHD and TD may affect the sleep pattern in an independent (additive) or in a complex (interactive) manner. METHOD: By means of polysomnography, sleep patterns were investigated in 4 groups of unmedicated 8.0-16.4-year-old children (healthy controls, ADHD-only, TD-only, and ADHD + TD). Each group consisted of 18 subjects matched for age, gender, and intelligence. RESULTS: ADHD was primarily characterized by increase in rapid eye movement (REM) sleep, whereas TD patients displayed lower sleep efficiency and elevated arousal index in sleep. In children with ADHD + TD, both effects appeared. No interaction between the ADHD and TD factors was found for any of the sleep parameters. Significant correlations between sleep patterns and clinical symptoms were found. CONCLUSIONS: ADHD and TD are characterized by specific sleep alterations. When coexisting, the two disorders alter the sleep pattern in an additive manner, suggesting a high impact on clinical and therapeutic perspectives.     

Parent–child hostility and child ADHD symptoms: a genetically sensitive and longitudinal analysis

Background:  Families of children with attention-deficit/hyperactivity disorder (ADHD) report higher rates of conflict within the family and more negative parent–child relationships. This study aimed to test whether negative parent–child relationships have a risk effect on ADHD symptoms using two complementary designs.
Method:  The first sample included 886 twin pairs, aged 11–17 years, derived from a population-based twin study. The second sample was derived from a longitudinal community study and included 282 parents and their children, aged 11–14 years. Questionnaires were used to assess ADHD symptoms and hostility in the mother–child and father–child relationship. Bivariate genetic analysis was used to test the contribution of genetic and environmental factors to the association between parent–child hostility and ADHD symptoms in the twin sample. Cross-lagged and reciprocal effects models were used to test for a bidirectional relationship between parent–child hostility and ADHD symptoms over time in the longitudinal study.
Results:  For boys, both genetic and environmental factors contributed to the link between mother–son hostility and ADHD symptoms, but genetic factors alone explained the association between father–son hostility and ADHD symptoms. For girls, the association between ADHD symptoms and mother–daughter hostility as well as father–child hostility was attributed to genetic factors alone. The longitudinal study provided evidence of boys' ADHD symptoms impacting upon mother–son hostility both within and across time. There were no effects in the opposite direction.
Conclusions:  A causal hypothesis of family relations influencing ADHD symptoms was not supported. Boys' ADHD symptoms appear to have an environmentally mediated impact upon mother–son hostility.     

癫癎患儿共患注意缺陷多动障碍的临床分析

目的：评估癫癎患儿共患注意缺陷多动障碍（ADHD）的共患率,探讨引起癫癎患儿共患ADHD的相关危险因素。方法：选取符合癫癎和癫癎综合征诊断标准、年龄在6～15岁的患儿256例,调查癫癎患儿与ADHD的共患率及危险因素。结果：192例患儿完成系统评定。ADHD的共患率为42.2%。首次发作年龄越早,抗癫癎药物治疗时程越长及多种抗癫癎药物联合应用者癫癎共患ADHD的共患率越高;Lennox-Gastaut 综合征和全身强直-阵挛发作型癫癎及脑电图提示多病灶起源的癫癎患儿ADHD共患率较高。结论：ADHD在癫癎患儿中的共患率较高。癫癎患儿共患ADHD相关的危险因素包括：癫癎的首次发作年龄、癫癎发作类型、癫癎综合征的类型、脑电图特征及抗癫癎药物的使用。     

Tourette syndrome associated with attention deficit hyperactivity disorder: The impact of tics and psychopharmacological treatment options

Tourette syndrome (TS) is a neurodevelopmental disorder characterized by multiple chronic motor and vocal tics beginning in childhood. Several studies describe the association between TS and attention deficit hyperactivity disorder (ADHD). Fifty percent of children diagnosed with ADHD have comorbid tic disorder. ADHD related symptoms have been reported in 35% to 90% of children with TS. Since ADHD is the most prevalent comorbid condition with TS and those with concomitant TS and ADHD present with considerable psychosocial and behavioral impairments, it is essential for clinicians to be familiar with these diagnoses and their management. This paper highlights the association between treating ADHD with stimulants and the development of tic disorders. The two cases discussed underscore the fact that children with TS may present with ADHD symptomatology prior to the appearance of any TS related symptoms. Appropriate management of TS in a patient diagnosed with ADHD can lead to quality of life improvements and a reduction in psychosocial impairments.