Çevikaslan Ahmet, Parlak Mesut, Ellidağ Hamit Yaşar, Kulaksızoğlu Sibel Çilingiroğlu, Yılmaz Necat
Child and Adolescent Psychiatry Clinic, Antalya Training and Research Hospital, Turkey.
Pediatric Endocrinology Division, Akdeniz University School of Medicine, Antalya, Turkey.
Scand J Child Adolesc Psychiatr Psychol. 2021 Sep 9;9:163-173. doi: 10.21307/sjcapp-2021-018. eCollection 2021.
Adverse effects of stimulants on growth in children have long been studied, but the results remain to be clarified, because metabolic changes or predictors accompanying the growth deviations were not sufficiently studied. This open label-prospective study investigated the effects of methylphenidate (MPH) on weight, height, blood biochemistry in children with attention deficit hyperactivity disorder (ADHD). Prepubertal boys treated with MPH in Child and Adolescent Psychiatry Clinic at Antalya Training and Research Hospital in Health Sciences University, Turkey were recruited. Height and weight z-scores and fasting blood samples were taken at baseline and 6 month. Changes were compared by paired-samples t-test or Wilcoxon signed-rank test. Any association between the changes in growth and biochemical values was analyzed by Spearman's Rank-Order Correlation. The statistical significance threshold was p<0.01. 31 boys aged 74 to 104 months were enrolled in the study sample (mean=87.6, Standard Deviation (SD)=9.2). Osmotic release oral system-MPH (18 mg/day) was used in 77.4% (N=24) and immediate release-MPH (5 mg three times a day) in 22.5% (N=7). Average daily drug dose was 0.66 mg/kg (SD=0.12). Baseline weight z-score was 0.63 (SD=1.12), decreased significantly at 6 months (0.24 [SD=1.04]) (Z=-4.44, p=0.000, r=0.5) (median z-score was 0.53 at baseline, -0.11 at 6 months). Baseline height z-score (0.23[SD=0.87]) was not suppressed significantly at 6 months (0.28[SD=0.85])(t(30) = ‒1.50, =0.14). Glucose (t(30) = -4.33, =0.000, r=0.6), creatinine (t(30)=-3.28, =0.003, =0.5) and 25OH-VitD (N=29, Z=-3.98, =0.000, =0.5) increased but alkaline phosphatase (ALP) decreased (t(28)=3.63, =0.001, =0.5). The differences in W-SDS and ALP were positively correlated (=0.47, =0.009). Our results indicate the importance of monitoring blood variables that may accompany growth changes early in MPH treatment and should be further assessed in larger samples.
兴奋剂对儿童生长的不良影响长期以来一直受到研究，但结果仍有待阐明，因为伴随生长偏差的代谢变化或预测因素尚未得到充分研究。这项开放标签前瞻性研究调查了哌甲酯（MPH）对注意力缺陷多动障碍（ADHD）儿童体重、身高和血液生化指标的影响。招募了在土耳其健康科学大学安塔利亚培训与研究医院儿童与青少年精神病诊所接受MPH治疗的青春期前男孩。在基线和6个月时测量身高和体重z评分以及空腹血样。通过配对样本t检验或Wilcoxon符号秩检验比较变化情况。通过Spearman等级相关分析生长变化与生化值之间的任何关联。统计学显著性阈值为p<0.01。31名年龄在74至104个月的男孩纳入研究样本（平均=87.6，标准差（SD）=9.2）。77.4%（N=24）使用渗透释放口服系统MPH（18毫克/天），22.5%（N=7）使用速释MPH（5毫克，每日三次）。平均每日药物剂量为0.66毫克/千克（SD=0.12）。基线体重z评分为0.63（SD=1.12），在6个月时显著下降（0.24[SD=1.04]）（Z=-4.44，p=0.000，r=0.5）（基线时z评分中位数为0.53，6个月时为-0.11）。基线身高z评分（0.23[SD=0.87]）在6个月时未受到显著抑制（0.28[SD=0.85]）（t（30） = -1.50，p=0.14）。血糖（t（30） = -4.33，p=0.000，r=0.6）、肌酐（t（30）=-3.28，p=0.003，r=0.5）和25OH-维生素D（N=29，Z=-3.98，p=0.000，r=0.5）升高，但碱性磷酸酶（ALP）降低（t（28）=3.63，p=0.001，r=0.5）。W-SDS和ALP的差异呈正相关（r=0.47，p=0.009）。我们的结果表明，在MPH治疗早期监测可能伴随生长变化的血液变量很重要，并且应该在更大样本中进一步评估。
