ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
ADHD Outpatient Program & Development Psychiatry Program, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Psychiatry, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
Brain Behav Immun. 2021 Oct;97:239-249. doi: 10.1016/j.bbi.2021.08.004. Epub 2021 Aug 8.
There is a high comorbidity between attention-deficit/hyperactivity disorder (ADHD) and asthma, and inflammation has been proposed as a potential pathophysiological mechanism behind this association. Most studies conducted so far have used a cross-sectional design, and none has evaluated the prevalence of asthma symptoms in patients with ADHD followed from childhood to adulthood. We relied on data from the 1993 Pelotas birth cohort to evaluate the association between ADHD and asthma in patients with distinct patterns of incidence, persistence and remission, and to explore the potential role of inflammatory markers in the comorbidity. We analyzed data from 3281 individuals from the 1993 Pelotas birth cohort collected at birth (1993), 11 years (2004), 18 years (2011), and 22 years (2015). Subjects were first classified according to their ADHD and asthma status as early-onset (EO) persistent (positive screening for ADHD at 11 years and diagnosis of ADHD according to DSM-5, except criterion E, at either 18 or 22 years), EO-remittent (positive screening for ADHD at 11 years only), late-onset (diagnosis of ADHD according to DSM-5, except criterion E, at 18 or 22 years only), or healthy subjects (negative for both conditions in all evaluation). After controlling for confounders, significant associations were observed between EO-remittent ADHD and EO-remittent asthma (OR 1.68, 95% CI 1.11-2.55), EO-persistent ADHD and EO-persistent asthma (OR 4.33, 95% CI 1.65-11.34), and between late-onset ADHD and late-onset asthma (OR 1.86, 95% CI 1.28-2.70), suggesting a state-dependent association. Serum interleukin-6 (IL-6) and C-reactive protein (CRP) were measured at the 18- and 22-year evaluations and compared between subjects positive for ADHD, asthma, and subjects with both or none conditions, regardless of the previously defined trajectories. Subjects with comorbid ADHD and asthma presented higher levels of IL-6 at the 18- and 22-year evaluations when compared to subjects negative for both conditions. Our results demonstrate a state-dependent association between ADHD and asthma despite underlying trajectories. Higher levels of serum IL-6 in patients with both conditions suggest that a pro-inflammatory environment might have a role in the pathophysiological mechanisms underlying the comorbidity.
注意缺陷多动障碍(ADHD)和哮喘之间存在高度共病性,炎症被认为是这种关联背后的潜在病理生理机制。迄今为止,大多数研究都采用了横断面设计,没有研究评估从儿童期到成年期持续存在的 ADHD 患者中哮喘症状的患病率。我们依赖于 1993 年佩洛塔斯出生队列的数据,以评估具有不同发病、持续和缓解模式的 ADHD 与哮喘之间的关联,并探讨炎症标志物在共病中的潜在作用。我们分析了来自 1993 年佩洛塔斯出生队列的 3281 名个体的数据,这些个体在出生时(1993 年)、11 岁(2004 年)、18 岁(2011 年)和 22 岁(2015 年)进行了采集。根据他们的 ADHD 和哮喘状况,受试者首先被分类为早发性(EO)持续性(11 岁时 ADHD 筛查阳性,且根据 DSM-5,除外 E 标准,18 岁或 22 岁时 ADHD 诊断)、早发性缓解(仅 11 岁时 ADHD 筛查阳性)、晚发性(18 岁或 22 岁时仅根据 DSM-5 诊断 ADHD,除外 E 标准)或健康受试者(所有评估中两种情况均为阴性)。在控制混杂因素后,EO 缓解型 ADHD 和 EO 缓解型哮喘(OR 1.68,95%CI 1.11-2.55)、EO 持续型 ADHD 和 EO 持续型哮喘(OR 4.33,95%CI 1.65-11.34)以及晚发性 ADHD 和晚发性哮喘(OR 1.86,95%CI 1.28-2.70)之间存在显著关联,表明存在状态依赖性关联。在 18 岁和 22 岁的评估中测量了血清白细胞介素 6(IL-6)和 C 反应蛋白(CRP),并将其与 ADHD、哮喘阳性以及无论之前定义的轨迹如何均具有两种或均无条件的受试者进行了比较。与两种情况均为阴性的受试者相比,同时患有 ADHD 和哮喘的受试者在 18 岁和 22 岁的评估中 IL-6 水平更高。我们的结果表明,尽管存在潜在轨迹,但 ADHD 和哮喘之间存在状态依赖性关联。同时患有两种疾病的患者的血清 IL-6 水平更高,这表明促炎环境可能在共病的病理生理机制中发挥作用。