注意缺陷多动障碍患儿视频脑...图异常改变与智力水平的关系_李向娥.pdf

Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期注意缺陷多动障碍患儿视频脑电图异常改变与智力水平的关系李向娥1，弓汶钰2，王瑞31.榆林市第一医院神经电生理室，陕西榆林719000；2.榆林市第一医院脑电图室，陕西榆林719000；3.榆林市星元医院脑电图室，陕西榆林719000【摘要】目的分析注意缺陷多动障碍(ADHD)患儿视频脑电图(EGG)异常改变与智力水平的关系。方法选取2020年5月至2022年5月在榆林市第一医院治疗的82例ADHD患儿作为研究对象(ADHD组)，根据性别分为ADHD男性组、ADHD女性组，以年龄10岁为界限，分为ADHD组-1组(年龄10岁)、ADHD组-2组(年龄1012岁)，选取50例健康儿童作为健康组。所有入组儿童均行脑电图检查，按照检测结果将ADHD组患儿分为正常组和异常组，采用 中国韦氏儿童智力量表(C-WISC)检测并比较各组儿童的智力水平总智商(FIQ)、语言智商(VIQ)、操作智商(PIQ)，并采用Spearman相关性分析法分析患儿脑电图异常改变与智力、性别、年龄的相关性。结果ADHD组患儿的FIQ、VIQ、PIQ分别为(89.8714.35)分、(84.2413.45)分、(96.1213.51)分，明显低于健康组的(106.6411.83)分、(105.2612.65)分、(107.3311.67)分，差异均有统计学意义(P0.05)；ADHD组患儿的视频脑电图异常率为28.05%，明显高于健康组的10.00%，差异有统计学意义(P0.05)；ADHD患儿中，视频脑电图异常组患儿的FIQ、VIQ、PIQ分别为(76.4114.56)分、(76.3810.18)分、(92.5613.56)分，明显低于视频脑电图正常组的(91.7912.39)分、(85.9113.06)分、(99.0512.59)分，差异均有统计学意义(P0.05)；ADHD男性组患儿的PIQ为(100.8713.00)分，明显高于ADHD女性组的(93.4012.26)分，而VIQ、FIQ分别为(79.2511.31)分、(86.7917.35)分，明显低于ADHD女性组的(87.4113.45)分、(88.2011.43)分，差异均有统计学意义(P0.05)；ADHD-1组和ADHD-2组患儿的FIQ、VIQ、PIQ评分比较差异均无统计学意义(P0.05)，ADHD-1组和ADHD-2组患儿的异常发生率分别为60.87%、39.13%，差异无统计学意义(P0.05)；经Spearman相关性分析结果显示，ADHD患儿的视频脑电图异常改变与VIQ、PIQ和FIQ评分呈负相关(r=-0.837、-0.864、-0.844，P 均0.001)。结论ADHD患儿视频脑电图异常改变与患儿智力水平存在相关性，ADHD患儿视频脑电图异常率高于健康儿童，且性别可能影响ADHD患儿视频脑电图异常表现类型。【关键词】注意缺陷多动障碍；脑电图；智力；性别；年龄；相关性【中图分类号】R729【文献标识码】A【文章编号】10036350（2023）13189305Relationship between abnormal changes of video electroencephalogram and intelligence level in children withattention deficit hyperactivity disorder.LI Xiang-e1,GONG Wen-yu2,WANG Rui3.1.Department of NerveElectrophysiology,Yulin First Hospital,Yulin 719000,Shaanxi,CHINA;2.Electroencephalogram Room,Yulin FirstHospital,Yulin 719000,Shaanxi,CHINA;3.Electroencephalogram Room,Yulin Xingyuan Hospital,Yulin 719000,Shaanxi,CHINA【Abstract】ObjectiveTo analyze the relationship between abnormal changes of video electroencephalogram(EGG)and intelligence level in children with attention deficit hyperactivity disorder(ADHD).MethodsA total of 82children with ADHD treated in Yulin First Hospital between May 2020 and May 2022 were enrolled as the research ob-jects(ADHD group).According to genders,they were divided into ADHD male group and ADHD female group.Accord-ing to age,they were divided into ADHD-1 group(10 years)and ADHD-2 group(10 to 12 years).A total of 50 healthychildren were enrolled as healthy group.According to EEG results,patients in ADHD group were divided into normalgroup and abnormal group.The intelligence level full-scale intelligence quotient(FIQ),verbal intelligence quotient(VIQ),performance intelligence quotient(PIQ)in different groups was detected and compared by Chinese Wechsler In-telligence Scale for Children(C-WISC).The correlation between abnormal changes of video EEG and intelligence,gen-der,age was analyzed by Spearman analysis.ResultsThe scores of FIQ,VIQ,and PIQ in ADHD group were(89.8714.35)points,(84.2413.45)points,and(96.1213.51)points,significantly lower than(106.6411.83)points,(105.2612.65)points,(107.3311.67)points in healthy group(P0.05)，具有可比性。本研究经我院伦理委员会批准，所有入组者监护人均签署知情同意书。1.2检测方法1.2.1脑电图检测所有入组者均进行EEG检测。采用上海诺诚无线蓝牙脑电仪按国际10/20系统放置法安放电极，在儿童脑部放置19个头皮，双侧耳垂电极为参考电极，使用单极、双极导联记录及描述。高频滤波(HF)60 Hz，低频滤波(LF)0.5 Hz，陷波滤波(NF)50 Hz，时间常数(TC)为0.3 s，记录速度30 mm/s。敏感性100 V/cm，描记中做数次闭眼诱发试验和3 min过度换气诱发试验。过度换气结束后再继续记录至少1 min，如有异常继续记录直至异常现象消失。每例有效描记时间20 min，排除眼动等伪差。将诊断结果以波、波、波等波形变化情况进行描述。1.2.2智力测定采用参考文献6中的韦氏儿童智力量表对两组儿童进行智力水平测量。该量表主要分为语言及操作分类量表，共11项测试，分别计算各分测验量表得到言语量表的智商(Verbal Intelli-gence Qoutient，VIQ)、操作量表的智商(PerformanceIntelligence Quotient，PIQ)及总智商(Full-Scale Intelli-gence Quotient，FIQ)。量表分值以70分为界值，70分为智力低下。1.3统计学方法应用SPSS22.0统计学软件对本研究数据进行分析。计量资料符合正态分布，以均数标准差(x-s)表示，组间比较采用t检验，计数资料比较采用2检验，采用Spearman相关性分析法分析患儿脑电图异常改变与智力、性别、年龄的相关性。以P0.05表示差异有统计学意义。2结果2.1ADHD组和健康组儿童的智力水平比较AD-HD组患儿的VIQ、PIQ、FIQ值明显低于健康组，差异均有统计学意义(P0.05)，见表1。significantly higher than that in healthy group(28.05%vs 10.00%),and the difference was statistically significant(P0.05).The scores of FIQ,VIQ,and PIQ in abnormal EEG group were(76.4114.56)points,(76.3810.18)points,and(92.5613.56)points,significantly lower than(91.7912.39)points,(85.9113.06)points,(99.0512.59)points in nor-mal group(P0.05).PIQ score inADHD male group was significantly higher than that in ADHD female group:(100.8713.00)points vs(93.4012.26)points;while scores of VIQ and FIQ were significantly lower than those in ADHD femalegroup:(79.2511.31)points vs(87.4113.45)points,(86.7917.35)points vs(88.2011.43)points;the differences werestatistically significant(P0.05).The difference in scores of FIQ,VIQ and PIQ be-tween ADHD-1 group and ADHD-2 group was not statistically significant(P0.05).There was no significant differencein incidence of abnormal EEG between ADHD-1 group and ADHD-2 group(60.87%vs 39.13%,P0.05).The results ofSpearman correlation analysis showed that abnormal changes of video EEG are negatively correlated with VIQ,PIQ,and FIQ scores in ADHD children(r=-0.837,-0.864,-0.844,P0.001).ConclusionThe abnormal changes of videoEEG are correlated with intelligence level in ADHD children.The abnormal rate of video EEG in ADHD children ishigher than that in healthy children.Gender may affect the types of abnormal video EEG.【Key words】Attention deficit hyperactivity disorder;Electroencephalogram;Intelligence;Gender;Age;Corre-lation1894Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期2.2ADHD 组和健康组儿童的脑电图异常情况比较ADHD组患儿的视频脑电图异常率为28.05%，明显高于健康组的 10.00%，差异有统计学意义(2=6.054，P=0.0140.05)，见表2。2.3ADHD患儿中脑电图异常组与正常组儿童的智力水平比较视频脑电图异常组患儿的VIQ、PIQ、FIQ值明显低于正常组，差异均有统计学意义(P0.05)，见表3。表1 ADHD组和健康组儿童的智力水平比较(x-s，分)Table 1Comparison of intelligence level between ADHD group andhealthy group(x-s,points)组别ADHD组健康组t值P值例数8250VIQ84.2413.45105.2612.658.9060.001PIQ96.1213.51107.3311.673.9650.001FIQ89.8714.35106.6411.836.9460.001表2ADHD组和健康组儿童的脑电图异常情况比较(例)Table 2Comparison of abnormal EEG between ADHD group and healthy group(n)组别ADHD组健康组例数8250波欠整齐90波增多不对称64/比值降低20波增多不对称41/比值降低20脑电图异常率(%)28.0510.002.4男性组和女性组患儿的脑电图异常情况和智力水平比较ADHD男性组患儿的PIQ评分明显高于女性组，VIQ、FIQ评分明显低于女性组，差异均有统计学意义(P0.05)，见表4。2.5不同年龄阶段患儿的视频脑电图异常情况和智力水平比较以10岁为界限，分为ADHD组-1组(年龄0.05)，见表5。表3ADHD患儿中脑电图异常组与正常组儿童的智力水平比较(x-s，分)Table 3Comparison of intelligence levels between children withabnormal EEG and those with normal EEG in childrenwith ADHD(x-s，points)组别异常组正常组t值P值例数2359VIQ76.3810.1885.9113.063.1460.002PIQ92.5613.5699.0512.592.0520.043FIQ76.4114.5691.7912.394.8040.001表4男性组和女性组患儿的脑电图异常情况和智力水平比较x-s，例(%)Table 4Comparison of abnormal EEG and intelligence level between female group and male group x-s,n(%)组别男性组女性组t/2值P值例数4240VIQ(分)79.2511.3187.4113.452.9790.004PIQ(分)100.8713.0093.4012.262.6740.009FIQ(分)86.7917.3588.2011.4323.2820.001波不对称1(2.38)5(12.50)3.0930.079波不对称6(14.29)5(12.50)0.0560.813波不对称5(11.90)1(2.50)2.6720.1022.6脑电图异常情况与智力水平的相关性经Spearman相关性分析结果显示，视频脑电图异常与其VIQ、PIQ和FIQ水平呈负相关(r=-0.837、-0.864、-0.844，P均0.001)。3讨论ADHD患儿因为运动前回与前额皮层葡萄糖代谢率减低，导致注意力不集中。神经细胞突触间隙中的神经递质不足，信息不能上传7-8，进而造成大脑皮层调节觉醒与抑制功能所需的兴奋不足，导致患儿无法控制自身行为。以上原因导致ADHD患儿外在表现为年龄不相称的注意力不集中、多动、冲动9-10，以及较差的阅读理解、语言缺陷、知觉推理、工作记忆等能力。本研究以韦氏儿童智力量表第四版对ADHD患儿及健康儿童智力水平进行研究比较，研究结果显示，ADHD组患儿VIQ、PIQ、FIQ分数均低于健康组，提示ADHD组患儿在语言和操作能力上与正常儿童存在一定差异。多年来ADHD患儿智力诊断及预后判定以临床为主，以韦氏儿童智力量表等量表作为参考，脑功能检测也以心理测验方法为主，缺乏诊断及疗效评估的客观指标11-12。脑电图以捕捉大脑某个区域神经细胞群的电位变化为依据，通过快速傅里叶转换等表5不同年龄阶段患儿的视频脑电图异常情况和智力水平比较x-s，例(%)Table 5Comparison of abnormal EEG and intelligence level in children at different age groups x-s,n(%)组别ADHD-1组ADHD-2组t/2值P值例数5329VIQ(分)83.6914.1182.4010.840.4280.670PIQ(分)96.2112.5399.0814.170.9470.347FIQ(分)87.0216.1188.3111.870.3780.706脑电图异常率14(60.87)9(39.13)0.1980.656功率2.140.672.330.851.1150.268功率3.130.993.431.421.1210.266功率2.490.631.950.421.1560.2511895海南医学2023年7月第34卷第13期Hainan Med J,Jul.2023,Vol.34,No.13方式，将患儿脑功能活动过程的变化通过各频段脑电波分布变化显示出来，使脑功能情况得到更直观的观察13。对 ADHD患儿脑功能损伤情况的诊断更加精确，且可以持续无创地反映脑功能水平14-15。本研究以脑电图检测为标准对ADHD组患儿和健康儿童脑电图异常情况进行比较，结果显示，ADHD组视频脑电图异常率高于健康组，且ADHD组视频脑电图波活动减少，波、波活动增多，波形不规则。从脑电波的特异性对其原因进行推测，脑电波主要通过频率及波幅变化记录大脑神经元活动，受神经元物质、神经云兴奋性等影响，当ADHD患儿神经元代谢减慢，神经元兴奋度将降低，脑电波频率受影响，最终体现在视频脑电图的异常上16。儿童脑电图频率随着年龄增长由慢变快，波增加。波为闭目清醒状态下的脑电图波形，波幅升高表明神经元细胞兴奋，大脑皮层对觉醒与抑制功能的调节增强。因此，健康人在清醒时波脑电图波形处于升高趋势，波在反映儿童认知行为成长中具有重要作用17。波、波是慢波，是脑组织抑制过程在一定程度上的反映。/作为脑波绝对功率比值，比值越小提示患者的脑功能状态越差18。因此根据本研究显示结果分析，ADHD组视频脑电图波活动减少，波、波活动增多，且波形不规则，提示AD-HD组儿童脑神经元兴奋性降低，中枢神经处于低觉醒状态。ADHD组患儿视频脑电图异常率高于健康组，提示ADHD组患儿神经元异常。ADHD患儿神经元代谢减慢，神经元兴奋度降低，导致适宜调节无法强化，不利调节无法抑制，进而影响儿童注意力、动作协调性与操作能力，出现动作增多、注意力不集中等症状19。同时神经元兴奋度降低，导致脑波慢化，在视频脑电图上体现出来。当前研究认为ADHD患儿脑电图异常主要表现为波、波增多，波、波活动减弱。且ADHD女患儿脑电图异常表现为波、波的不对称性，男患儿以波和波不对称为主要表现20，本文研究结果与其相一致。推测其原因在于男女性激素分泌、SLC6A2基因分布性别差异等。且本研究结果显示，ADHD女性组PIQ分数高于ADHD男性组，VIQ分数低于ADHD男性组，差异具有统计学意义，与Biederman等21研究结果相一致；该研究表明女性更偏向于物质使用障碍方面，男性患儿则在阅读等方面障碍较严重。Ruck-lidge等22也认为男女ADHD患儿在临床症状上表现不同。儿童大脑皮层随着年龄增长逐渐发育完善，因此目前普遍认为儿童脑电图频率由慢变快，幅度普遍下降，波、波逐渐减少，波增加。Poil等23研究发现ADHD脑电图异常随着患儿年龄增长发生改变，功率更高，功率更低。本研究显示，ADHD-1组视频脑电图异常率大于ADHD-2组，提示儿童ADHD患病率与年龄有一定关系，但两组智力水平、异常类型及异常率比较差异均无统计学意义，推测原因在于本研究样本量较小，需要增加样本量进一步研究。一般认为ADHD患儿智商正常或者略低于正常儿童，就本文研究结果来看，ADHD组VIQ、PIQ、FIQ水平略低于健康组，且视频脑电图异常组VIQ、PIQ、FIQ水平低于正常组，Spearman相关性分析ADHD视频脑电图异常与智商水平呈负相关，提示ADHD视频脑电图异常程度越严重，患儿智力水平越低。综上所述，ADHD患儿视频脑电图异常与其智力水平具有一定的相关性，具体表现在ADHD视频脑电图异常率越高，患儿智力水平分数越低。ADHD患儿视频脑电图结合C-WISC能够作为患儿智力障碍及严重程度诊断辅助依据之一。本文研究不足在于样本量较少，性别及年龄对ADHD患儿智力水平的影响，及其在视频脑电图异常中的相关性仍需要进行大范围、多中心、前瞻性研究，以进一步加以证实。参考文献1Development Behavior Group of Pediatric Society of Chinese Medi-cal Association.Pediatric expert consensus on early recognition,stan-dardized diagnosis and treatment of attention deficit hyperactivity dis-order J.Chinese Journal of Pediatrics,2020,58(3):188-193中华医学会儿科学分会发育行为学组.注意缺陷多动障碍早期识别、规范诊断和治疗的儿科专家共识J.中华儿科杂志,2020,58(3):188-193.2Li SM,Feng W,Fang F,et al.Prevalence of attention deficit and hy-peractivity disorder in children in China:a systematic review and me-ta-analysis J.Chinese Journal of Epidemiology,2018,39(7):993-998.李世明,冯为,方芳,等.中国儿童注意缺陷多动障碍患病率Meta分析J.中华流行病学杂志,2018,39(7):993-998.3Gong Y,Luo H,Wang DL,et al.Analysis of behavioral characteris-tics of different subtypes of attention deficit hyperactivity disorderJ.Zhejiang Clinical Medical Journal,2022,24(1):45-47.龚云,骆宏,王东林,等.注意缺陷多动障碍不同亚型行为特征分析J.浙江临床医学,2022,24(1):45-47.4 Chen XM,Liang GJ,Li MD,et al.Effect of aerobic exercise on coresymptoms and executive function in children with attention deficithyperactivity disorder J.Chinese Journal of Rehabilitation Theoryand Practice,2022,28(6):704-709.陈小明,梁冠军,李明娣,等.有氧运动对注意缺陷多动障碍儿童核心症状和执行功能的影响J.中国康复理论与实践,2022,28(6):704-709.5Blanger SA.Canadian Paediatric Society clinical practice recom-mendations for children and adolescents with attention-deficit hyper-activity disorder J.Paediatr Child Health,2018,23(7):431-432.6Lin WX,Wang X,Wu JL,et al.Intelligence structure characteristicof attention deficit hyperactivity disorder children in WISC-J.Chinese Journal of Child Health Care,2012,20(1):58-61.1896Hainan Med J,Jul.2023,Vol.34,No.13海南医学2023年7月第34卷第13期林文璇,王馨,吴婕翎,等.韦氏儿童智力量表第四版在注意缺陷多动障碍儿童智力结构分析中的应用J.中国儿童保健杂志,2012,20(1):58-61.7Wang KC,Yao Y,Guo LL,et al.Abnormal cerebral cortex structurein patients with different subtypes of attention deficit hyperactivitydisorder J.Chinese Journal of Psychiatry,2021,54(5):363-373.王康程,姚媛,郭玲玲,等.注意缺陷多动障碍不同亚型患者的脑皮质结构特征分析J.中华精神科杂志,2021,54(5):363-373.8Mous SE,White T,Muetzel RL,et al.Cortical morphology as ashared neurobiological substrate of attention-deficit/hyperactivitysymptoms and executive functioning:A population-based pediatricneuroimaging study J.J Psychiatry Neurosci,2017,42(2):103-112.9 Drechsler R,Brem S,Brandeis D,et al.ADHD:Current concepts andtreatments in children and adolescents J.Neuropediatrics,2020,51(5):315-335.10 Yu ZZ,Yang BR,Zhang SH,et al.Intellectual characteristics of chil-dren with attention deficit hyperactivity disorder and developmentaldyslexia J.Chinese Journal of Contemporary Pediatrics,2021,23(2):148-152.余珍珠,杨斌让,张姗红,等.注意缺陷多动障碍共患发展性阅读障碍儿童的智力特征J.中国当代儿科杂志,2021,23(2):148-152.11 Xie QF,Liu YW,Xie YY,et al.Application of the SNAP-and theIntegrated Visual and Auditory Continuous Performance Test in eval-uating attention deficit hyperactivity disorder J.Chinese Journal ofApplied Clinical Pediatrics,2022,37(2):121-125.谢庆凤,刘一苇,谢媛媛,等.SNAP-评定量表与视听整合连续测试在评估注意缺陷多动障碍中的价值J.中华实用儿科临床杂志,2022,37(2):121-125.12 Sun JL,Wu DD,Liu QQ.Clinical application of auxiliary diagnostictools for preschool attention deficit hyperactivity disorder J.Journalof Neuroscience and Mental Health,2022,22(1):68-72.孙金磊,吴丹丹,刘倩琦.学龄前注意缺陷多动障碍辅助诊断工具的临床应用J.神经疾病与精神卫生,2022,22(1):68-72.13 Hadas I,Hadar A,Lazarovits A,et al.Right prefrontal activation pre-dicts ADHD and its severity:A TMS-EEG study in young adults J.Prog Neuropsychopharmacol Biol Psychiatry,2021,111:110340.14 Bong SH,Kim JW.The role of quantitative electroencephalogram inthe diagnosis and subgrouping of attention-deficit/hyperactivity disor-der J.Soa Chongsonyon Chongsin Uihak,2021,32(3):85-92.15 Furlong S,Cohen JR,Hopfinger J,et al.Resting-state EEG connec-tivity in young children with ADHD J.J Clin Child Adolesc Psy-chol,2021,50(6):746-762.16 Zheng JB,Ning SY,Wang CB,et al.Changes and significance ofquantitative EEG parameters and serum Cor,IL-8,IFN-and T lym-phocyte subsets in children with ADHD comorbid with TS J.Shan-dong Medical Journal,2021,61(23):67-71.郑健斌,宁书尧,王长兵,等.ADHD共患TS患儿定量脑电图参数与血清Cor、IL-8、IFN-、T淋巴细胞亚群变化及意义J.山东医药,2021,61(23):67-71.17 Wang FH,Sun LY,Cui XM,et al.Comparative efficacy of targetedstructural patterns of electroencephalography neurofeedback in chil-dren with inattentive or combined attention deficit hyperactivity dis-order J.Brain Behav,2022,12(6):e2572.18 Xu B,Yuan XD,Zhang PS,et al.Predictive value of quantitative elec-troencephalogram indexes on the state of consciousness in patientswith acute brain injury J.Practical Journal of Cardiac CerebralPneumal and Vascular Disease,2022,30(4):52-59.徐斌,元小冬,张萍淑,等.定量脑电图指标对急性脑损伤患者意识状态的预测价值研究J.实用心脑肺血管病杂志,2022,30(4):52-59.19 Leon C,Sharma R,Kaur S.Attention-deficit/hyperactive disorder:Missing the bulls eye J.Evid Based Ment Health,2019,22(1):e1.20 Zhang KX,Zhang G.Neuroimaging characteristics of children withdifferent subtypes of attention-deficit/hyperactivity disorder J.Chi-nese Journal of School Health,2022,43(5):796-800.张可馨,张功.注意缺陷多动障碍儿童神经影像学研究进展J.中国学校卫生,2022,43(5):796-800.21 Biederman J,Faraone SV,Monuteaux MC,et al.Gender effects on at-tention-deficit/hyperactivity disorder in adults,revisited J.Biol Psy-chiatry,2004,55(7):692-700.22 Rucklidge JJ.Gender differences in attention-deficit/hyperactivitydisorder J.Psychiatr Clin North Am,2010,33(2):357-373.23 Poil SS,Bollmann S,Ghisleni C,et al.Age dependent electroenceph-alographic changes in attention-deficit/hyperactivity disorder(AD-HD)J.Clin Neurophysiol,2014,125(8):1626-1638.(收稿日期：2022-11-03)1897