广西医学

目的探讨维生素D联合盐酸哌甲酯治疗在合并维生素D缺乏的注意缺陷多动障碍（ADHD）患儿中的应用效果。方法将63例合并维生素D缺乏的ADHD患儿随机分为对照组（n=32）和观察组(n=31)。对照组患儿口服盐酸哌甲酯治疗，观察组患儿口服盐酸哌甲酯及维生素D治疗。比较两组治疗前和治疗12周后的斯旺森-诺兰-佩勒姆Ⅳ评定量表（SNAP-Ⅳ）-父母版评分、困难儿童问卷（QCD）评分、Conners父母评定量表（CPRS）评分及血清25-羟维生素D［25-(OH)D］水平。记录两组患儿治疗过程中不良反应的发生情况。结果治疗后，两组的SNAP-Ⅳ-父母版各维度评分及总评分较治疗前下降，且观察组的上述评分低于对照组（P＜0.05）；两组的QCD评分较治疗前提高，且观察组的QCD评分高于对照组（P＜0.05）；两组的品行问题维度、学习问题维度、冲动-多动维度和多动指数维度评分较治疗前降低，且观察组上述维度评分低于对照组（P＜0.05）。治疗期间两组患儿的食欲减退、呕吐及腹泻、睡眠障碍、头晕等不良反应发生率差异无统计学意义（P＞0.05）。结论维生素D联合盐酸哌甲酯治疗可明显改善合并维生素D缺乏的ADHD患儿的核心症状和社会功能，减少其行为问题，且效果优于单纯盐酸哌甲酯治疗，安全性较好。

ObjectiveTo explore the application effect of vitamin D combined with methylphenidate hydrochloride in children with attention deficit and hyperactive disorder (ADHD) and concomitant vitamin D deficiency. MethodsA total of 63 ADHD children and concomitant vitamin D deficiency were randomly assigned to control group (n=32) or observation group (n=31). The control group received oral administration of methylphenidate hydrochloride for treatment, and the observation group received oral administration of methylphenidate hydrochloride and vitamin D for treatment. The Swanson-Nolan-Pelham Ⅳ Rating Scale (SNAP-Ⅳ) for parent version score, Questionnaire-Children with Difficulties (QCD) score, Conners Parents Rating Scale (CPRS) score, and serum 25 hydroxyvitamin D (25-［OH］D) level before treatment and 12 weeks after treatment were compared between the two groups. The occurrence of adverse reactions during treatment was recorded in both groups. ResultsAfter treatment, both groups yielded decreased scores of SNAP-Ⅳ for parent version in various dimensions and total score as compared with before treatment, and the aforementioned scores of the observation group were lower than those of the control group (P＜0.05); in addition, the QCD score of both groups was increased as compared with before treatment, and the observation group exhibited a higher QCD score as compared with the control group (P＜0.05); furthermore, both groups interpreted decreased scores in conduct problem dimension, learning problem dimension, impulsivity-hyperactivity dimension, and hyperactivity index dimension as compared with before treatment, and the observation group interpreted lower scores of aforesaid dimensions as compared with the control group (P＜0.05). There was no statistically significant difference in adverse reactions involving anorexia, vomiting and diarrhea, sleep disorder, and dizziness, etc.,between children of the two groups during treatment (P＞0.05). ConclusionVitamin D combined with methylphenidate hydrochloride therapy can prominently ameliorate core symptoms and social function of ADHD children and concomitant vitamin D deficiency, and reduce their conduct problems, exerting superior effect to compare with methylphenidate hydrochloride therapy alone, with a favorable safety.