Garcia Ricardo J, Francis Lisa, Dawood Maha, Lai Zhi-Wei, Faraone Stephen V, Perl Andras
State University of New York Upstate Medical University, Syracuse 13210, USA.
Arthritis Rheum. 2013 May;65(5):1313-8. doi: 10.1002/art.37893.
To investigate whether attention deficit hyperactivity disorder (ADHD) may serve as a marker of neuropsychiatric disease and as a target for N-acetylcysteine (NAC) treatment in patients with systemic lupus erythematosus (SLE).
The ADHD Self-Report Scale (ASRS) was used to assess 49 patients with SLE and 46 matched healthy control subjects. Twenty-four of the patients with SLE were randomized to receive either placebo, NAC at a dosage of 2.4 gm/day, or NAC at a dosage of 4.8 gm/day. Disease activity was evaluated monthly using the British Isles Lupus Assessment Group (BILAG) index, the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI), the Fatigue Assessment Scale (FAS), and the ASRS, before and during the 3-month treatment period and after a 1-month washout period.
The cognitive/inattentive (ASRS part A), hyperactivity/impulsive (ASRS part B), and combined (total) ASRS scores were increased in patients with SLE compared with control subjects (mean ± SEM 17.37 ± 1.03 [P = 3 × 10(-7) ], 14.51 ± 0.89 [P = 2 × 10(-4) ], and 31.92 ± 1.74 [P = 8 × 10(-7) ], respectively, versus 10.41 ± 1.02, 9.61 ± 1.21, and 20.02 ± 1.98, respectively. ASRS part A scores correlated with SLEDAI (r = 0.53, P < 0.0001) and BILAG scores (r = 0.36, P = 0.011). ASRS total scores also correlated with SLEDAI (r = 0.45, P = 0.0009) and BILAG scores (r = 0.31, P = 0.025). ASRS part A (r = 0.73, P < 0.0001), ASRS part B (r = 0.47, P = 0.0006), and ASRS total scores (r = 0.67, P < 0.0001) correlated with the FAS score. Relative to the scores in placebo-treated patients, ASRS total scores were reduced in SLE patients treated with NAC dosages of 2.4 gm/day and 4.8 gm/day combined (P = 0.037). ASRS part A scores were reduced by NAC dosages of 2.4 gm/day (P = 0.001) and 4.8 gm/day (P < 0.0001) as well as by NAC at dosages of 2.4 gm/day and 4.8 gm/day combined (P = 0.001).
In patients with SLE, elevated ASRS scores reveal previously unrecognized and clinically significant symptoms of ADHD that respond to NAC treatment.
研究注意缺陷多动障碍（ADHD）是否可作为神经精神疾病的标志物以及系统性红斑狼疮（SLE）患者N - 乙酰半胱氨酸（NAC）治疗的靶点。
采用ADHD自陈量表（ASRS）对49例SLE患者和46例匹配的健康对照者进行评估。24例SLE患者被随机分为接受安慰剂、每日剂量2.4 g的NAC或每日剂量4.8 g的NAC治疗。在3个月治疗期之前、期间以及1个月洗脱期之后，每月使用不列颠群岛狼疮评估组（BILAG）指数、系统性红斑狼疮疾病活动指数（SLEDAI）、疲劳评估量表（FAS）和ASRS评估疾病活动度。
与对照者相比，SLE患者的认知/注意力不集中（ASRS A部分）、多动/冲动（ASRS B部分）及综合（总分）ASRS评分升高（平均±标准误分别为17.37±1.03 [P = 3×10⁻⁷]、14.51±0.89 [P = 2×10⁻⁴]和31.92±1.74 [P = 8×10⁻⁷]，而对照者分别为10.41±1.02、9.61±1.21和20.02±1.98）。ASRS A部分评分与SLEDAI（r = 0.53，P < 0.0001）和BILAG评分（r = 0.36，P = 0.011）相关。ASRS总分也与SLEDAI（r = 0.45，P = 0.0009）和BILAG评分（r = 0.31，P = 0.025）相关。ASRS A部分（r = 0.73，P < 0.0001）、ASRS B部分（r = 0.47，P = 0.0006）及ASRS总分（r = 0.67，P < 0.0001）与FAS评分相关。相对于接受安慰剂治疗患者的评分，接受每日剂量2.4 g和4.8 g联合NAC治疗的SLE患者的ASRS总分降低（P = 0.037）。每日剂量2.4 g（P = 0.001）和4.8 g（P < 0.0001）的NAC以及每日剂量2.4 g和4.8 g联合的NAC均可降低ASRS A部分评分（P = 0.001）。
在SLE患者中，升高的ASRS评分揭示了先前未被认识到的且具有临床意义的ADHD症状，这些症状对NAC治疗有反应。
