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【目的】通过对注意缺陷多动障碍(attention deficity hyperactivity disorder,ADHD)、抽动障碍(tic disor-der,TD)、TD共患ADHD儿童的下丘脑-垂体-肾上腺(HPA)轴功能状态进行研究,探讨HPA轴在ADHD、TD及TD共患ADHD中的作用。【方法】TD、ADHD的诊断根据精神障碍与诊断手册第4版(DSM-IV)诊断标准。血浆皮质醇及ACTH检测分别采用全自动微粒酶免疫分析法及电化学发光法,于上午8:00空腹进行。【结果】ADHD组血浆皮质醇水平[(214.43±84.28)nmol/L]低于对照组[(353.32±112.75)nmol/L,P<0.001],而TD组皮质醇水平[(337.54±120.45)nmol/L]与对照组[353.32±112.75)nmol/L]比较差异无统计学意义(P>0.05)。TD共患ADHD组血浆皮质醇水平[(223.30±133.73)nmol/L]较TD组与对照组儿童明显降低(P<0.001),而与ADHD组比较差异无统计学意义。而各组血浆ACTH水平相互进行比较,均无统计学意义。【结论】ADHD儿童以及TD共患ADHD均存在着HPA轴调节功能障碍,而TD的HPA轴调节功能正常。血浆皮质醇与抽动症状相关性小,而与注意缺陷、多动、冲动行为关系更为密切。
【Objective】 To investigate the functional status of hypothalamus-pituitary-adrenal (HPA) axis in children with ADHD and attention deficit hyperactivity disorder (ADHD), tic disor-der (TD) To investigate the role of HPA axis in ADHD, TD and TD comorbid ADHD. 【Methods】 The diagnosis of TD and ADHD was based on the Diagnostic Handbook of Mental Disorders and Diagnostic Manual, Fourth Edition (DSM-IV). Plasma cortisol and ACTH were detected by automated enzyme-linked immunosorbent assay and electrochemiluminescence, fasting at 8:00 am. 【Results】 The plasma cortisol level in ADHD group was lower than that in control group [(214.43 ± 84.28) nmol / L [(353.32 ± 112.75) nmol / L, P <0.001] nmol / L] and control group [353.32 ± 112.75 nmol / L], there was no significant difference (P> 0.05). The level of plasma cortisol in patients with TD comorbid ADHD [(223.30 ± 133.73) nmol / L] was significantly lower than that in TD and controls (P <0.001), but not significantly different from those in ADHD. The plasma ACTH levels in each group compared with each other, were not statistically significant. 【Conclusion】 There are dysfunction of HPA axis regulation in ADHD children and AD children with TD, while TDA has normal HPA axis regulation function. Plasma cortisol and tic symptoms less relevant, but with attention deficit hyperactivity, impulsive behavior more closely.