小儿黄龙颗粒联合盐酸托莫西汀治疗注意缺陷多动障碍的临床疗效观察
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摘要
目的观察小儿黄龙颗粒联合盐酸托莫西汀治疗注意缺陷多动障碍(ADHD)的临床疗效。方法选取2015年10月至2016年9月期间诊断为ADHD,中医证属肝肾阴虚证的72例患儿,按照随机数字表法分为对照组和治疗组各36例。对照组单纯使用盐酸托莫西汀进行治疗,治疗组采用小儿黄龙颗粒和盐酸托莫西汀联合治疗。观察两组患儿治疗后临床疗效及Conners评分、SNAP-4量表评分情况。结果治疗8周后,对照组总有效率为69. 44%,治疗组为75. 00%,两组比较差异无统计学意义(P> 0. 05)。两组患儿Conners评分比较,治疗4周后,治疗组在冲动-多动及多动指数的评分与对照组有明显差异(P <0. 05);治疗8周后,治疗组在心身障碍及多动指数的评分与对照组比较差异有统计学意义(P <0. 05)。治疗4周后,治疗组SNAP-4评分与对照组存在显著差异(P <0. 05),而治疗8周后两组间比较差异无统计学意义(P> 0. 05)。结论小儿黄龙颗粒联合盐酸托莫西汀治疗ADHD证属肝肾阴虚者,能缩短起效时间,提高疗效,值得临床推广。
Objective To observe the clinical therapeutic effects on attention deficit hyperactivity disorder( ADHD) treated with the combined medication with xiaoer huanglong granules and atomoxetine hydrochloride. Methods A total of 72 children diagnosed as ADHD of liver and kidney yin deficiency syndrome in TCM were collected from October2015 to September 2016. According to the random number table,they were divided into a control group and a treatment group,36 cases in each one. In the control group,atomoxetine hydrochloride was simply used. In the treatment group,xiaoer huanglong granules were combined with atomoxetine hydrochloride. The clinical therapeutic effects,Conners score and SNAP-4 score were observed after treatment in the two groups. Results After 8-week treatment,the total effective rate was 69. 44% in the control group and was 75. 00% in the treatment group,without significant difference in comparison( P> 0. 05). Regarding the comparison of Conners scores in ADHD children between the two groups,after 4-week treatment,the index score of the compulsive behaviors-hyperactivity and hyperactivity in the treatment group was different obviously as compared with the control group( P < 0. 05). After 8-week treatment,the index score of the psychosomatic disorder and hyperactivity in the treatment group was different significantly as compared with the control group( P < 0. 05). After 4-week treatment,SNAP-4 score in the treatment group was different significantly as compared with the control group( P< 0. 05) and after 8-week treatment,the difference was not significant between the two groups( P > 0. 05). Conclusion The combined medication with xiaoer huanglong granules and atomoxetine hydrochloride shortens the onset time and improves the therapeutic effects on ADHD differentiated as liver and kidney yin deficiency in TCM. This therapy deserves to be promoted in clinical practice.
Objective To observe the clinical therapeutic effects on attention deficit hyperactivity disorder( ADHD) treated with the combined medication with xiaoer huanglong granules and atomoxetine hydrochloride. Methods A total of 72 children diagnosed as ADHD of liver and kidney yin deficiency syndrome in TCM were collected from October2015 to September 2016. According to the random number table,they were divided into a control group and a treatment group,36 cases in each one. In the control group,atomoxetine hydrochloride was simply used. In the treatment group,xiaoer huanglong granules were combined with atomoxetine hydrochloride. The clinical therapeutic effects,Conners score and SNAP-4 score were observed after treatment in the two groups. Results After 8-week treatment,the total effective rate was 69. 44% in the control group and was 75. 00% in the treatment group,without significant difference in comparison( P> 0. 05). Regarding the comparison of Conners scores in ADHD children between the two groups,after 4-week treatment,the index score of the compulsive behaviors-hyperactivity and hyperactivity in the treatment group was different obviously as compared with the control group( P < 0. 05). After 8-week treatment,the index score of the psychosomatic disorder and hyperactivity in the treatment group was different significantly as compared with the control group( P < 0. 05). After 4-week treatment,SNAP-4 score in the treatment group was different significantly as compared with the control group( P< 0. 05) and after 8-week treatment,the difference was not significant between the two groups( P > 0. 05). Conclusion The combined medication with xiaoer huanglong granules and atomoxetine hydrochloride shortens the onset time and improves the therapeutic effects on ADHD differentiated as liver and kidney yin deficiency in TCM. This therapy deserves to be promoted in clinical practice.
引文
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[12]郭玉清,韩新民,朱先康,等.儿童多动症中医临床路径的应用效果分析[J].中国中西医结合杂志,2015,35(12):1469-1473.
[13]刘小凡,马融,丁樱,等.小儿黄龙颗粒治疗注意缺陷多动障碍随机、双盲双模拟、多中心临床研究[J].中国实验方剂学杂志,2014,20(2):171-176.
[14]古今楠,马融.益智宁神颗粒对于注意缺陷多动障碍动物模型认知功能的影响[J].中华中医药杂志,2008,23(10):910-912.
[15]孙继超,韩新民,郭玉清,等. 270例儿童多动症中医证型分布及演变规律探讨[J].辽宁中医杂志,2016,43(5):908-910.
[16]吕姗珊,唐桂英,杨超,等.小儿黄龙颗粒对记忆障碍模型小鼠学习记忆功能的影响[J].中国实验方剂学杂志,2014,20(14):172-177.
[17]谯志文,吕姗珊,陈晓雪,等.小儿黄龙颗粒对APO模型小鼠多动异常行为的影响[J].中华中医药杂志,2013,28(10):2914-2916.
[2]苏林雁.儿童精神医学[M].湖南:湖南科学技术出版社,2014:226.
[3]Fredriksen M,Dahl AA,Martinsen EW,et al. Effectiveness of one-year pharmacological treatment of adult attention-deficit/hyperactiv-ity disorder(ADHD):an open-label prospective study of time intreatment,dose,side-effects and comorbidity[J]. Eur Neuropsycho-pharmacol,2014,24(12):1873-1884.
[4]Childress AC. A critical appraisal of atomoxetine in the managementof ADHD[J]. Ther Clin Risk Manag,2015(12):27-39.
[5]American Psychiatric Association.精神障碍诊断与统计手册[M].随道龙,译. 5版.北京:北京大学出版社,2015:55-62.
[6]国家中医药管理局医政司. 24个专业105个病种中医诊疗方案(合订本)[M].北京:中国中医药出版社,2011:490.
[7]冷方南,凌耀星,彭国忱.儿童多动症临床治疗学[M].北京:人民军医出版社,2010:394.
[8]Van der Oord S,Prins PJ,Oosterlaan J,et al. Efficacy of methylpheni-date,psychosocial treatments and their combination in school-agedchildren with ADHD:a meta-analysis[J]. Clin Psychol Rev,2008,28(5):783-800.
[9]Thapar A,Cooper M,Eyre O,et al. What have we learnt about thecauses of ADHD?[J]. J Child Psychol Psychiatry,2013,54(1):3-16.
[10]Tarver J,Daley D,Sayal K. Attention-deficit hyperactivity disorder(ADHD):an updated review of the essential facts[J]. Child CareHealth Dev,2014,40(6):762-774.
[11]Koda K,Ago Y,Cong Y,et al. Effects of acute and chronic adminis-tration of atomoxetine and methylphenidate on extracellular levels ofnoradrenaline,dopamine and serotonin in the prefrontal cortex andstriatum of mice[J]. J Neurochem,2010,114(1):259-270.
[12]郭玉清,韩新民,朱先康,等.儿童多动症中医临床路径的应用效果分析[J].中国中西医结合杂志,2015,35(12):1469-1473.
[13]刘小凡,马融,丁樱,等.小儿黄龙颗粒治疗注意缺陷多动障碍随机、双盲双模拟、多中心临床研究[J].中国实验方剂学杂志,2014,20(2):171-176.
[14]古今楠,马融.益智宁神颗粒对于注意缺陷多动障碍动物模型认知功能的影响[J].中华中医药杂志,2008,23(10):910-912.
[15]孙继超,韩新民,郭玉清,等. 270例儿童多动症中医证型分布及演变规律探讨[J].辽宁中医杂志,2016,43(5):908-910.
[16]吕姗珊,唐桂英,杨超,等.小儿黄龙颗粒对记忆障碍模型小鼠学习记忆功能的影响[J].中国实验方剂学杂志,2014,20(14):172-177.
[17]谯志文,吕姗珊,陈晓雪,等.小儿黄龙颗粒对APO模型小鼠多动异常行为的影响[J].中华中医药杂志,2013,28(10):2914-2916.