Chuang Wei-Chen, Yeh Chin-Bin, Wang Sheng-Chiang, Pan Pei-Yin, Shyu Jia-Fwu, Liu Yia-Ping, Gau Susan Shur-Fen, Lu Ru-Band
Department of Psychiatry, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Department of Psychiatry, Tri-Service General Hospital, Songshan Branch, Taipei, Taiwan.
Front Psychiatry. 2019 Jun 26;10:437. doi: 10.3389/fpsyt.2019.00437. eCollection 2019.
Methylphenidate (MPH) is highly effective in controlling the symptoms of attention-deficit/hyperactivity disorder (ADHD), but some children with ADHD either do not respond to, or do not tolerate, treatment. Dextromethorphan (DM) is a neuroprotective agent which has been used in the treatment of neuropsychiatric disorders. This clinical trial had examined the effect of DM on the use of MPH in the children with ADHD. This randomized double-blind clinical trial had evaluated 44 male outpatients, aged between 6 and 12 years, with a diagnosis of ADHD. The study subjects were randomly assigned into one of the two groups: receiving MPH alone (15-60 mg per day) or MPH plus DM (30-60 mg per day) for 8 weeks. Assessments, comprising the Chinese version of the conducted by parents and the serum cytokines measured by microarray and enzyme-linked immunosorband assay (ELISA), were compared between groups at baseline and at 8 weeks after the medication was started. There were a significant decrease at the mean scores of both CBCL-C and SNAP-IV scales after 8 weeks of treatment, but no significant differences between MPH and MPH+DM groups. Compared with the MPH-only group, the mean scores of some psychometric parameters reported on the CBCL-C and SNAP-IV scales regarding time effects as well as the attention problems on the CBCL-C scale regarding group effect were significantly higher in the DM+MPH group. Although there were no significant differences in the levels of various serum cytokines between groups, the subjects in the DM-MPH group had relatively fewer and lower levels of adverse effects. Significant interactions were found between the withdrawn/depression item reported on the CBCL-C scale and tumor necrosis factor α (ခTNF-α) ( = 0.027), as well as between thought problems item on the CBCL-C and TNF-α ( = 0.028) in subjects who had received DM+MPH treatment. Following the trial, DM+MPH was not superior to MPH alone for the treatment of children with ADHD, yet DM may potentially have negative effects on ADHD symptoms when combined with MPH. Clinicaltrials.gov, trial number: NCT01787136.
哌甲酯（MPH）在控制注意力缺陷多动障碍（ADHD）症状方面非常有效，但一些患有ADHD的儿童对治疗无反应或不耐受。右美沙芬（DM）是一种神经保护剂，已用于治疗神经精神疾病。这项临床试验研究了DM对ADHD儿童使用MPH的影响。这项随机双盲临床试验评估了44名年龄在6至12岁之间、被诊断为ADHD的男性门诊患者。研究对象被随机分为两组之一：单独接受MPH（每天15 - 60毫克）或MPH加DM（每天30 - 60毫克），为期8周。在基线和开始用药8周后，比较两组之间由父母进行的中文版评估以及通过微阵列和酶联免疫吸附测定（ELISA）测量的血清细胞因子。治疗8周后，CBCL - C和SNAP - IV量表的平均得分均显著下降，但MPH组和MPH + DM组之间无显著差异。与仅使用MPH组相比，DM + MPH组在CBCL - C和SNAP - IV量表上报告的一些心理测量参数关于时间效应的平均得分以及CBCL - C量表上关于组效应的注意力问题的平均得分显著更高。虽然两组之间各种血清细胞因子水平无显著差异，但DM - MPH组的受试者不良反应相对较少且程度较低。在接受DM + MPH治疗的受试者中，发现CBCL - C量表上报告的退缩/抑郁项目与肿瘤坏死因子α（TNF - α）之间存在显著交互作用（P = 0.027），以及CBCL - C上的思维问题项目与TNF - α之间存在显著交互作用（P = 0.028）。试验结束后，DM + MPH在治疗ADHD儿童方面并不优于单独使用MPH，但DM与MPH联合使用时可能对ADHD症状产生负面影响。Clinicaltrials.gov，试验编号：NCT01787136。
