Chou I-Ching, Lin Che-Chen, Kao Chia-Hung
From the Department of Pediatrics, China Medical University Hospital (I-CC), Graduate Institute of Integrated Medicine, College of Chinese Medicine (I-CC), Management Office for Health Data, China Medical University Hospital (C-CL), College of Medicine (C-CL), Graduate Institute of Clinical Medical Science and School of Medicine, College of Medicine (C-HK), Department of Nuclear Medicine and PET Center, China Medical University Hospital, Taichung, Taiwan (C-HK).
Medicine (Baltimore). 2015 Apr;94(16):e707. doi: 10.1097/MD.0000000000000707.
Enterovirus (EV) infection is a major public health issue throughout the world with potential neurological complications. This study evaluated the relationship between attention deficit hyperactivity disorder (ADHD) and EV encephalitis in children.Data of reimbursement claims from the National Health Insurance Research Database of Taiwan were used in a population-based case-control design. The study comprised 2646 children with ADHD who were matched according to sex, age, urbanization level of residence, parental occupation, and baseline year, to people without ADHD at a ratio of 1:10. The index date of the ADHD group was the ADHD date of diagnosis. Histories of EV infections before the index dates were collected and recategorized according to the severity of infection.Compared with children without EV infection, the children with mild EV infection had a 1.16-fold increased risk of ADHD (odds ratio [OR] = 1.16, 95% confidence interval [CI] = 1.07-1.26), and the children with severe EV infection had a greater risk of ADHD (OR = 2.82, 95% CI = 1.05-7.57). The results also revealed a significant correlation between ADHD and the severity of EV infection (P for trend = 0.0001).Patients with EV encephalitis have an increased risk of developing ADHD. Although most EV encephalitis in children has a favorable prognosis, it may be associated with significant long-term neurological sequelae, even in children considered fully recovered at discharge. Neuropsychological testing should be recommended for survivors of childhood EV encephalitis. The causative factors between EV encephalitis and the increased risk of ADHD require further investigation.
肠道病毒（EV）感染是一个全球性的重大公共卫生问题，可能引发神经系统并发症。本研究评估了儿童注意力缺陷多动障碍（ADHD）与EV脑炎之间的关系。基于台湾全民健康保险研究数据库的报销申请数据，采用了基于人群的病例对照设计。该研究纳入了2646名患有ADHD的儿童，这些儿童根据性别、年龄、居住地区城市化水平、父母职业和基线年份，以1:10的比例与未患ADHD的人群进行匹配。ADHD组的索引日期为ADHD诊断日期。收集索引日期之前的EV感染病史，并根据感染严重程度重新分类。与未感染EV的儿童相比，轻度EV感染的儿童患ADHD的风险增加了1.16倍（优势比[OR]=1.16，95%置信区间[CI]=1.07-1.26），而重度EV感染的儿童患ADHD的风险更高（OR=2.82，95%CI=1.05-7.57）。结果还显示ADHD与EV感染严重程度之间存在显著相关性（趋势P值=0.0001）。EV脑炎患者患ADHD的风险增加。尽管大多数儿童EV脑炎预后良好，但即使是出院时被认为已完全康复的儿童，也可能伴有严重的长期神经后遗症。对于儿童EV脑炎幸存者，应建议进行神经心理学测试。EV脑炎与ADHD风险增加之间的因果因素需要进一步研究。
