Poulton Alison S, Bui Quoc, Melzer Elaine, Evans Richard
aSydney Medical School Nepean, University of Sydney bDepartment of Medical Imaging, Nepean Blue Mountains Local Health District, Nepean Hospital, Penrith, New South Wales, Australia.
Int Clin Psychopharmacol. 2016 Mar;31(2):93-9. doi: 10.1097/YIC.0000000000000109.
Stimulant medication is known to cause transient weight loss and slowing down of growth, but whether it delays physical maturation is unclear. We studied growth and bone age over the first 3 years of treatment in children with attention-deficit/hyperactivity disorder (patients) compared with healthy siblings (controls). Bone age was estimated blindly by two independent radiologists using Tanner and Whitehouse version 3. Dexamphetamine or methylphenidate was titrated and continued when clinically indicated. Forty out of 73 patients, together with 22 controls, completed the study. There were no significant growth differences between the two groups at baseline. Despite slower growth on treatment [5.1 cm/year, 95% confidence interval (CI): 4.7-5.5, vs. 6.3 cm/year, 95% CI: 5.7-6.8, P=0.002; and 2.7 kg/year, 95% CI: 2.1-3.3, vs. 4.4 kg/year, 95% CI: 3.5-5.3, P=0.005], the patients showed no significant maturational delay (RUS score: 49 U/year, 95% CI: 44-55, vs. 55 U/year, 95% CI: 47-63, P=0.27). A subgroup of patients underwent serial biochemistry and dual-energy X-ray absorptiometry, recording a significant reduction in fat (5.61±3.56-4.22±3.09 kg, P<0.001) and leptin (3.88±2.87-2.57±1.94 ng/ml, P=0.017). The pattern of change in height z-score over time was modified by the dose of medication (P for interaction=0.024). We found no medication effect on the rate of maturation, which was instead predicted by baseline leptin (P=0.035 controlling for age and sex).
已知刺激性药物会导致短暂体重减轻和生长放缓，但它是否会延迟身体成熟尚不清楚。我们研究了注意力缺陷多动障碍儿童（患者）与健康同胞（对照）在治疗的前3年中的生长情况和骨龄。由两名独立的放射科医生使用坦纳和怀特豪斯第3版方法对骨龄进行盲法评估。右旋苯丙胺或哌甲酯进行滴定，并在临床指征明确时持续用药。73名患者中的40名以及22名对照完成了研究。两组在基线时生长情况无显著差异。尽管治疗期间生长较慢[5.1厘米/年，95%置信区间（CI）：4.7 - 5.5，对比6.3厘米/年，95%CI：5.7 - 6.8，P = 0.002；以及2.7千克/年，95%CI：2.1 - 3.3，对比4.4千克/年，95%CI：3.5 - 5.3，P = 0.005]，但患者未出现显著的成熟延迟（RUS评分：49单位/年，95%CI：44 - 55，对比55单位/年，95%CI：47 - 63，P = 0.27）。一组患者接受了系列生化检查和双能X线吸收法检查，结果显示脂肪显著减少（5.61±3.56 - 4.22±3.09千克，P < 0.001）以及瘦素减少（3.88±2.87 - 2.57±1.94纳克/毫升，P = 0.017）。身高z评分随时间的变化模式受药物剂量影响（交互作用P = 0.024）。我们发现药物对成熟速率没有影响，相反，成熟速率由基线瘦素预测（控制年龄和性别后P = 0.035）。
