Liu Yi-Chun, Liao Yin-To, Chen Vincent Chin-Hung, Chen Yi-Lung
Department of Psychiatry, Changhua Christian Children's Hospital, Changhua 500010, Taiwan.
Department of Psychiatry, Changhua Christian Hospital, Changhua 500209, Taiwan.
Biomedicines. 2024 Oct 10;12(10):2304. doi: 10.3390/biomedicines12102304.
BACKGROUND/OBJECTIVES: The complex association between attention-deficit/hyperactivity disorder (ADHD) and methylphenidate (MPH) with precocious puberty (PP) is still unclear. This study aims to investigate the association between ADHD, MPH, and PP.
This is a nationwide cohort study including a total of 3,342,077 individuals, 186,681 with ADHD and 3,155,396 without. First, we compared the risk of PP between ADHD cases and non-ADHD cases. Second, we compared the risk of PP between MPH users and non-MPH users in patients with ADHD.
Patients with ADHD were at a greater risk of PP (adjusted hazard ratio [aHR], 2.01 [95% CI, 1.91-2.11]). In our moderation analyses, the female gender was a positive additive effect modifier of the association between ADHD and PP, whereas tics and intellectual disability were negative effect modifiers. In patients with ADHD, MPH users had a significantly lower risk of PP (aHR, 0.63 [95% CI 0.57-0.70]), and females had a negative effect modification on the association between MPH and PP.
Our study found that children with ADHD were at a greater risk of PP. Girls with ADHD were a group particularly vulnerable to PP. Comorbid tics or intellectual disability was associated with a lower risk of PP. Among patients with ADHD, MPH was protective against PP, especially in girls. However, these preliminary results need further validation due to the nature of them being from an electronic database study. Unmeasured confounding factors might affect the association between MPH and PP.
背景/目的：注意力缺陷多动障碍（ADHD）和哌甲酯（MPH）与性早熟（PP）之间的复杂关联仍不清楚。本研究旨在调查ADHD、MPH和PP之间的关联。
这是一项全国性队列研究，共纳入3342077人，其中186681人患有ADHD，3155396人未患ADHD。首先，我们比较了ADHD病例组和非ADHD病例组中PP的风险。其次，我们比较了ADHD患者中MPH使用者和非MPH使用者的PP风险。
ADHD患者患PP的风险更高（调整后风险比[aHR]，2.01[95%CI，1.91 - 2.11]）。在我们的调节分析中，女性是ADHD与PP关联的正向相加效应修饰因素，而抽动和智力残疾是负向效应修饰因素。在ADHD患者中，MPH使用者患PP的风险显著较低（aHR，0.63[95%CI 0.57 - 0.70]），且女性对MPH与PP之间的关联有负向效应修饰作用。
我们的研究发现，ADHD儿童患PP的风险更高。患有ADHD的女孩是特别易患PP的群体。合并抽动或智力残疾与较低的PP风险相关。在ADHD患者中，MPH对PP有保护作用，尤其是在女孩中。然而，由于这些初步结果来自电子数据库研究的性质，需要进一步验证。未测量的混杂因素可能会影响MPH与PP之间的关联。
