注意缺陷多动障碍儿童的心率变异性：一项初步研究。
Heart Rate Variability in Children with Attention-Deficit/Hyperactivity Disorder: A Pilot Study.
作者信息
Rukmani Malligurki Raghurama, Seshadri Shekhar P, Thennarasu Kandavel, Raju Trichur R, Sathyaprabha Talakad N
机构信息
Department of Neurophysiology, Bangalore, India.
Department of Child and Adolescent Psychiatry, Bangalore, India.
出版信息
Ann Neurosci. 2016 Jul;23(2):81-8. doi: 10.1159/000443574. Epub 2016 Jul 7.
BACKGROUND
Attention deficit/hyperactivity disorder (ADHD) is a common childhood neuropsychiatric disorder. Autonomic nervous system plays a vital role in attention, self-regulation, emotional stability and social affiliation, which are affected in ADHD. The prefrontal cortex, which is vital for attention, motor control, emotional regulation and higher order autonomic control, is hypofunctional in ADHD. In addition, catecholamine dysregulation is there.
PURPOSE
We hypothesized that there is autonomic dysfunction: reduction in overall heart rate variability (HRV) and sympathovagal imbalance in children with ADHD.
METHODS
Study criteria were drug-naïve ADHD children who were 7-12 years of age of either gender who fulfilled DSM-IV criteria for ADHD and did not have any associated comorbid psychiatric/neurological/medical disorders. Two hundred and seventy ADHD children were screened out of which only 12 were found eligible and 10 participated. Sample size was 20 (cases = 10, age- and gender-matched healthy controls = 10). Short-term HRV of both time and frequency domains were assessed by recording lead II electrocardiogram after using Tell-Show-Do, a behavior shaping technique. Comparison between groups was done using Mann-Whitney and Wilcoxon test. Demographic variables like age, height, weight and body mass index were similar between groups.
RESULTS
Among time domain parameters, SD of all NN intervals, square root of the mean of the sum of squares of differences between adjacent NN intervals and percentage of count of number of pairs of adjacent NN intervals differing by more than 50 ms were reduced in ADHD group with p < 0.05. Among frequency domain parameters, total power was reduced in ADHD group with p < 0.05, high frequency power (HF) was reduced in ADHD group with p < 0.01 and low frequency power to HF ratio was higher in ADHD group with p < 0.01.
CONCLUSION
There is autonomic dysfunction in children with ADHD - reduction in overall HRV with sympathovagal imbalance with sympathetic dominance.
背景
注意力缺陷多动障碍（ADHD）是一种常见的儿童神经精神疾病。自主神经系统在注意力、自我调节、情绪稳定和社会交往中起着至关重要的作用，而这些方面在ADHD中会受到影响。对注意力、运动控制、情绪调节和高级自主控制至关重要的前额叶皮质在ADHD中功能低下。此外，还存在儿茶酚胺调节异常。
目的
我们假设ADHD儿童存在自主神经功能障碍：整体心率变异性（HRV）降低以及交感神经与迷走神经失衡。
方法
研究标准为未使用过药物的7至12岁ADHD儿童，不限性别，符合ADHD的DSM-IV标准且无任何相关的合并精神/神经/医学疾病。筛查出270名ADHD儿童，其中仅12名被认为符合条件，10名参与研究。样本量为20（病例 = 10，年龄和性别匹配的健康对照 = 10）。使用行为塑造技术“告知-展示-做”后，通过记录II导联心电图评估时域和频域的短期HRV。组间比较采用曼-惠特尼检验和威尔科克森检验。年龄、身高、体重和体重指数等人口统计学变量在两组间相似。
结果
在时域参数中，ADHD组所有NN间期的标准差、相邻NN间期差值平方和均值的平方根以及相邻NN间期差值超过50毫秒的对数计数百分比均降低，p < 0.05。在频域参数中，ADHD组总功率降低，p < 0.05，高频功率（HF）降低，p < 0.01，低频功率与HF比值升高，p < 0.01。
结论
ADHD儿童存在自主神经功能障碍——整体HRV降低，伴有交感神经与迷走神经失衡且以交感神经占优势。
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