多动症儿童对不同剂量哌甲酯的损伤及行为反应：多模式治疗儿童多动症研究的滴定试验
Impairment and deportment responses to different methylphenidate doses in children with ADHD: the MTA titration trial.
作者信息
Greenhill L L, Swanson J M, Vitiello B, Davies M, Clevenger W, Wu M, Arnold L E, Abikoff H B, Bukstein O G, Conners C K, Elliott G R, Hechtman L, Hinshaw S P, Hoza B, Jensen P S, Kraemer H C, March J S, Newcorn J H, Severe J B, Wells K, Wigal T
机构信息
Clinical Psychiatry, Department of Psychiatry, Columbia University, New York, USA.
出版信息
J Am Acad Child Adolesc Psychiatry. 2001 Feb;40(2):180-7. doi: 10.1097/00004583-200102000-00012.
OBJECTIVE
Results of the NIMH Collaborative Multisite Multimodal Treatment Study of Children With Attention-Deficit/Hyperactivity Disorder (MTA) were analyzed to determine whether a double-blind, placebo-controlled methylphenidate (MPH) titration trial identified the best MPH dose for each child with attention-deficit/hyperactivity disorder (ADHD).
METHOD
Children with ADHD assigned to MTA medication treatment groups (n = 289) underwent a controlled 28-day titration protocol that administered different MPH doses (placebo, low, middle, and high) on successive days.
RESULTS
A repeated-measures analysis of variance revealed main effects for MPH dose with greater effects on teacher ratings of impairment and deportment (F3 = 100.6, n = 223, p = .0001; effect sizes 0.8-1.3) than on parent ratings of similar endpoints (F3 = 55.61, n = 253, p = .00001; effect sizes 0.4-0.6). Dose did not interact with period, dose order, comorbid diagnosis, site, or treatment group.
CONCLUSIONS
The MTA titration protocol validated the efficacy of weekend MPH dosing and established a total daily dose limit of 35 mg of MPH for children weighing less than 25 kg. It replicated previously reported MPH response rates (77%), distribution of best doses (10-50 mg/day) across subjects, effect sizes on impairment and deportment, as well as dose-related adverse events.
目的
对美国国立精神卫生研究所（NIMH）开展的注意力缺陷多动障碍儿童协作多中心多模式治疗研究（MTA）的结果进行分析，以确定双盲、安慰剂对照的哌甲酯（MPH）滴定试验是否能为每位注意力缺陷多动障碍（ADHD）儿童确定最佳MPH剂量。
方法
被分配到MTA药物治疗组的ADHD儿童（n = 289）接受了一项为期28天的对照滴定方案，该方案在连续几天内给予不同剂量的MPH（安慰剂、低剂量、中剂量和高剂量）。
结果
重复测量方差分析显示，MPH剂量存在主效应，对教师评定的损害和行为表现的影响（F3 = 100.6，n = 223，p = .0001；效应大小为0.8 - 1.3）大于对家长评定的类似终点的影响（F3 = 55.61，n = 253，p = .00001；效应大小为0.4 - 0.6）。剂量与时期、剂量顺序、共病诊断、研究地点或治疗组之间不存在交互作用。
结论
MTA滴定方案验证了周末服用MPH的疗效，并确定了体重小于25 kg儿童的MPH每日总剂量上限为35 mg。该方案重复了先前报道的MPH反应率（77%）、受试者最佳剂量的分布（10 - 50 mg/天）、对损害和行为表现的效应大小以及与剂量相关的不良事件。
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