Zhang H, Du M, Zhuang S
Department of Pediatrics, First Affiliated Hospital, Sun Yat-sen University, Guangzhou, P. R. China.
Neuropediatrics. 2010 Aug;41(2):55-9. doi: 10.1055/s-0030-1261893. Epub 2010 Aug 26.
Stimulant-associated growth deficits in children with attention deficit hyperactivity disorder (ADHD) have long been a concern. We chose 146 school age children diagnosed with ADHD being treated with methylphenidate (MPH) and 29 drug-free ADHD children, and followed them up for 2-4 years. We recorded the changes in height and weight after long-term methylphenidate treatment and analyzed the influence of confounding factors to growth in height, weight, and height velocity. The change of the gap between patients' height and mean height in the methylphenidate group was -1.86+/-0.82 cm ( P<0.001); in controls it was -0.26+/-0.51 cm ( P<0.05). The changes of height standard deviation score (SDS) in the methylphenidate group and controls were -0.14+/-0.23 SD ( P<0.001) and +0.05+/-0.10 SD ( P<0.05), respectively. The differences between the 2 groups were significant ( P<0.001). Both correlation and regression analyses indicated that the duration of treatment contributed significantly to the variance in change of height ( P<0.001). The height velocity was significantly attenuated in the first year. The change of the gap between the patients' weight and weight for height after methylphenidate was -0.14+/-1.25 kg ( P>0.05). From this study, a small but significant deceleration of height velocity has been identified as a long-term side effect of methylphenidate, the magnitude of the height deficit is related to the duration of treatment. Methylphenidate had no significant influence on weight and BMI values.
长期以来,注意力缺陷多动障碍(ADHD)患儿中与兴奋剂相关的生长发育迟缓一直备受关注。我们选取了146名诊断为ADHD且正在接受哌甲酯(MPH)治疗的学龄儿童以及29名未用药的ADHD儿童,并对他们进行了2至4年的随访。我们记录了长期哌甲酯治疗后身高和体重的变化,并分析了混杂因素对身高、体重和身高增长速度的影响。哌甲酯治疗组患者身高与平均身高之间差距的变化为-1.86±0.82厘米(P<0.001);对照组为-0.26±0.51厘米(P<0.05)。哌甲酯治疗组和对照组身高标准差评分(SDS)的变化分别为-0.14±0.23标准差(P<0.001)和+0.05±0.10标准差(P<0.05)。两组之间的差异具有显著性(P<0.001)。相关性分析和回归分析均表明,治疗持续时间对身高变化的方差有显著影响(P<0.001)。身高增长速度在第一年显著减缓。哌甲酯治疗后患者体重与身高对应的体重之间差距的变化为-0.14±1.25千克(P>0.05)。从这项研究中可以确定,身高增长速度出现轻微但显著的减缓是哌甲酯的一种长期副作用,身高不足的程度与治疗持续时间有关。哌甲酯对体重和体重指数值没有显著影响。