摘要
目的:探讨托莫西汀对注意缺陷多动障碍(ADHD)男孩临床症状的效果及其脑机制。方法:纳入符合美国精神障碍诊断与统计手册第4版ADHD诊断标准的男孩17例,以及年龄匹配的正常对照男孩24例。ADHD组接受12周托莫西汀治疗,使用ADHD评定量表(ADHD-RS)评估临床症状,并收集ADHD组治疗前后和正常对照组的静息态功能磁共振成像数据。将ADHD组基线状态与正常对照组的度中心性差异有统计学意义的脑区作为感兴趣区(ROI),与大脑其余体素进行Granger因果分析,探讨效应连接改变与症状改善之间的关系。结果:ADHD组治疗后的ADHD-RS总分低于治疗前[(52.1±10.9)vs.(43.9±9.3),P<0.05]。ADHD组基线右侧楔前叶的度中心性低于正常对照组[(0.05±0.20)vs.(0.46±0.26),P<0.05],并将其设为ROI。ADHD-RS减分率与自ROI至脑岛(r=-0.88)、中央盖区(r=-0.92)和中央后回(r=-0.94)的效应连接增强呈负相关,与自ROI到额下回(r=0.87)、自小脑前部至ROI(r=0.87)的效应连接增强呈正相关(均P<0.05)。结论:托莫西汀能够改善ADHD男孩的临床症状,其机制可能与默认模式网络和突显网络、额顶网络、感觉运动网络及小脑之间的效应连接改变有关。
Objective:To examine the effect of atomoxetine(ATX)on clinical symptoms of boys with attention deficit hyperactivity disorder(ADHD)and its neurobiological mechanism.Methods:Seventeen ADHD boys met the criteria of Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-IV),and 24 age-matched normal control boys were recruited.ADHD boys received atomoxetine for 12 weeks.Their clinical symptoms were assessed with ADHD Rating-Scale(ADHD-RS),and resting-state functional magnetic resonance imaging was scanned before and after-treatment.Normal boys were scanned only at baseline.Regions showed significant difference of degree centrality(DC)between ADHD boys and normal controls at baseline was selected as region of interest(ROI),and performed Granger Causality Analysis with rest voxels,to explore associations between clinical symptoms improvements and effective connectivity changes.Results:ADHD-RS total scores reduced significantly after ATX treatment[(52.1±10.9)vs.(43.9±9.3),P<0.05].At baseline,DC in right precuneus were significantly lower in ADHD boys than in controls[(0.05±0.20)vs.(0.46±0.26),P<0.05],and the cluster was set as ROI.Decreased ADHD-RS scores were negatively correlated with increased effective connectivity from ROI to insula(r=-0.88),Rolandic operculum(r=-0.92),and postcentral gyrus(r=-0.94),while positively correlated with increased effective connectivity from ROI to inferior frontal gyrus(r=0.87)and from anterior cerebellum to ROI(r=0.87,Ps<0.05).Conclusion:ATX could improve the ADHD clinical symptoms,and its underpinning mechanism may be altered effective connectivity between default mode network with salience,frontoparietal,sensorimotor network and cerebellum.
作者
傅朝
袁靖
裴栩瑶
王鹏
范自立
孙霄
王玉凤
杨莉
曹庆久
FU Zhao;YUAN Jing;PEI Xuyao;WANG Peng;FAN Zili;SUN Xiao;WANG Yufeng;YANG Li;CAO Qingjiu(Peking Universitp Sixth Hospital,Pekinn Universitp Instituto of Mental Health,NHC Key Lanoratoik ol Mental Health(Peking University),National Clinical Research Center for Mental Disorders(Peking Universitp Sixth Hospital),Beijing 160083,China)
出处
《中国心理卫生杂志》
CSCD
北大核心
2023年第2期97-102,共6页
Chinese Mental Health Journal
基金
国家重点研发计划(2016YFC1306103)
国家自然科学基金(81873804,81471382,81471381,81671358)
国家精神心理疾病临床医学研究中心(北京大学第六医院)自主探索基金(NCRC2020M01)。
关键词
注意缺陷多动障碍
托莫西汀
度中心性
效应连接
静息态功能磁共振成像
attention deficit hyperactive disorder
atomoxetine
degree centrality
effective connectivity
resting-state functional magnetic resonance imaging
