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目的探讨注意缺陷多动障碍(ADHD)患儿视觉P300和非匹配负波(MMN)的异常以及哌甲酯治疗前后P300和MMN的变化。方法应用美国脑电生理仪,检测41例未服药ADHD患儿和(ADHD组)35例健康儿童(NC组)的P300和MMN,对ADHD患儿给予哌甲酯(10～16 mg.d-1,口服,平均12 mg.d-1)治疗。治疗0.5 a,对36例ADHD患儿进行随访,复查P300和MMN,按照国际脑电图学会标准,在检查前停服哌甲酯3～7 d。结果 1.ADHD患儿P300-N2潜伏期和P3靶潜伏期[(275±21)ms、(340±20)ms]均长于NC组[(259±17)ms、(327±16)ms],二组比较差异有统计学意义(Pa<0.01);P300-P3靶波幅低于NC组[(3.0±1.8)μV vs(5.2±1.5)μV,P<0.05]。2.与NC组比较,ADHD患儿MMN潜伏期后移[(199±20)ms vs(180±23)ms,P<0.01],波幅降低[(3.2±1.5)μV vs(5.6±1.7)μV,P<0.01]。3.经哌甲酯治疗0.5 a,ADHD患儿随多动症状改善,P300-N2潜伏期[治疗前(275±21)ms vs治疗后(261±19)ms,P<0.01]和P3靶潜伏期均缩短[治疗前(340±20)ms,治疗后vs(329±19)ms,P<0.05],P3靶波幅升高[治疗前(3.0±1.8)μV vs治疗后(4.7±2.0)μV,P<0.01]。结论 ADHD患儿视觉P300和MMN存在变异。经哌甲酯治疗后,ADHD患儿脑诱发电位有一定变化,提示ADHD患儿注意缺陷等症状可以通过哌甲酯治疗得以改善。
Objective To investigate the abnormalities of visual P300 and non-matched negative (MMN) in children with attention deficit hyperactivity disorder (ADHD) and the changes of P300 and MMN before and after treatment with methylphenidate. Methods P300 and MMN in 41 children with ADHD and 35 healthy children (NC group) without ADHD were detected by American brain electrophysiological test. Methylphenidate (10-16 mg.d- 1, oral, an average of 12 mg.d-1) treatment. After treatment for 0.5 a, 36 children with ADHD were followed up, P300 and MMN were reviewed. Methylphenidate was stopped 3 to 7 days before the test according to the International Society of EEG Standards. P300-N2 latency and P3 latency [(275 ± 21) ms, (340 ± 20) ms] in ADHD children were longer than those in NC patients (259 ± 17 ms, 327 ± 16 ms, (P <0.01). The amplitude of P300-P3 target was lower than that of NC group [(3.0 ± 1.8) μV vs (5.2 ± 1.5) μV, P <0.05]. Compared with the NC group, the latency of MMN in children with ADHD was delayed [(199 ± 20) ms vs (180 ± 23) ms, P <0.01] and the amplitude of MMN decreased ([3.2 ± 1.5] μV vs (5.6 ± 1.7) μV , P <0.01]. After treatment with methylphenidate for 0.5 a, children with ADHD improved with prolonged hyperactivity. P300-N2 latency [275 ± 21 ms vs before treatment (261 ± 19 ms), P <0.01] and P3 latency Shortened (340 ± 20) ms before treatment and (329 ± 19) ms vs 329 ± 19 ms after treatment, and increased the amplitude of P3 target (3.0 ± 1.8 μV vs 4.7 ± 2.0 μV before treatment, P <0.01]. Conclusion There is variation of visual P300 and MMN in children with ADHD. After methylphenidate treatment, ADHD children have some changes in brain evoked potential, suggesting that ADHD children with attention deficit symptoms such as methylphenidate treatment can be improved.