Lancet子刊:多动症真的是“天才病”?来看看多动症儿童大脑结构有何不同

2022-03-05 MedSci原创 MedSci原创

在一个代表普通人群的样本中,9-10岁的多动症儿童与未受影响的同龄人在大脑结构测量上只有微小的差异。

小儿多动症是一种以注意力不集中、多动和冲动为主要特征的行为障碍,可伴有学习困难等表现。临床上分为注意缺陷多动组合型、注意缺陷为主型、多动冲动型三种类型。

有家长认为,多动症不用治,长大就好了,这种观点是不正确的。有研究表明,多动症如果没有得到及时治疗,症状会持续到青春期甚至成人期,它将终身影响一个人生活的各个方面,比如,工作适应能力较差,无法维持固定的工作;很难与他人融洽相处,社会关系紧张等。

结构性神经影像学研究已经发现了多动症儿童皮质和皮质下结构的各种异常。然而,迄今为止的研究没有采用大型的、非参考性的样本,也没有完整的潜在混杂变量的数据。为此,来自美国杜克大学精神卫生系的专家利用美国最大的儿科脑成像研究--青少年大脑和认知发展研究(ABCD)的数据,测试了患有和不患有ADHD的儿童之间的结构性MRI措施的差异。结果发表在Lancet Psychiatry杂志上。

在这项横断面研究中,研究人员使用了ABCD研究的基线人口统计学、临床和神经影像学数据,该研究在2016年9月1日至2018年8月31日期间招募了9-10岁的儿童,代表了美国人口的社会人口学特征。神经影像数据由ABCD团队进行集中的质量控制和处理。线性混合效应模型被用来估计与ADHD相关的79个大脑皮质厚度、皮质面积和皮质下体积的Cohen's d值。

结果共纳入10736名参与者(5592名男孩,5139名女孩;5692名白人,2165名西班牙裔,1543名黑人,221名亚裔,1100名其他种族或族裔),其中949人符合ADHD的标准,9787人不符合。在完整的模型中,共发现在79个脑部测量指标中,经过虚假发现率校正后,只有11个明显的差异,都表明患有ADHD的参与者的脑部测量指标减少。

其中,Cohen's d值很小,从-0.11到-0.06不等,而且使用更严格的比较组或替代诊断方法也没有意义的改变。模拟表明,即使存在大量的诊断错误分类,也有足够的统计能力来检测差异。

由此可见,在一个代表普通人群的样本中,9-10岁的多动症儿童与未受影响的同龄人在大脑结构测量上只有微小的差异。未来的研究可能需要结合其他核磁共振成像方式、新的统计方法或其他诊断分类,特别是旨在开发ADHD诊断生物标志物的研究。

 

参考文献:

Structural brain measures among children with and without ADHD in the Adolescent Brain and Cognitive Development Study cohort: a cross-sectional US population-based study. https://doi.org/10.1016/S2215-0366(21)00505-8

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    2022-06-30 howi
  2. [GetPortalCommentsPageByObjectIdResponse(id=1831480, encodeId=51e3183148002, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Thu Jun 30 00:03:14 CST 2022, time=2022-06-30, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199805, encodeId=e8b71199805b2, content=😂, beContent=null, objectType=article, channel=null, level=null, likeNumber=69, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/ajNVdqHZLLCrSITpN0DzicibhsHP4JubUaVSiaIeEZksPXLOibjrguLdBHtNI99Wib4LtNV0SFl71ibfiayO1axkp8edQ/132, createdBy=28512328442, createdName=XDuLog, createdTime=Sun Mar 06 04:39:53 CST 2022, time=2022-03-06, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199640, encodeId=f29411996408e, content=学习了, beContent=null, objectType=article, channel=null, level=null, likeNumber=63, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220222/09120c6c907546f2833b89808b3b5cb1/5b3e8ffe84c34759b3fa8a8221380b4c.jpg, createdBy=961a2237245, createdName=Sandra欢, createdTime=Sat Mar 05 13:47:26 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1199638, encodeId=a461119963843, content=关注方向不同, beContent=null, objectType=article, channel=null, level=null, likeNumber=57, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=d45c3489814, createdName=1313195bm54暂无昵称, createdTime=Sat Mar 05 13:40:46 CST 2022, time=2022-03-05, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1348673, encodeId=c84113486e375, content=<a href='/topic/show?id=bf444306e0f' target=_blank style='color:#2F92EE;'>#多动症#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=54, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43067, encryptionId=bf444306e0f, topicName=多动症)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=19ad38, createdName=lq1767, createdTime=Thu Mar 03 06:03:14 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1424044, encodeId=edd9142404424, content=<a href='/topic/show?id=34db439533f' target=_blank style='color:#2F92EE;'>#大脑结构#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=32, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=43953, encryptionId=34db439533f, topicName=大脑结构)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3d9a3889985, createdName=shanyongle, createdTime=Thu Mar 03 06:03:14 CST 2022, time=2022-03-03, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1556539, encodeId=706015565399b, content=<a href='/topic/show?id=ab7e85001cf' target=_blank style='color:#2F92EE;'>#脑结构#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=37, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=85001, encryptionId=ab7e85001cf, topicName=脑结构)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=4f3114785325, createdName=wmr116, createdTime=Thu Mar 03 06:03:14 CST 2022, time=2022-03-03, status=1, ipAttribution=)]
    2022-03-06 XDuLog

    😂

    0

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    2022-03-05 Sandra欢

    学习了

    0

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    2022-03-05 1313195bm54暂无昵称

    关注方向不同

    0

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    2022-03-03 lq1767
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    2022-03-03 wmr116

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