中国妇幼保健

目的 分析学龄期注意缺陷多动障碍(ADHD)儿童用药前后维生素A和维生素D水平与ADHD症状的相关性，为ADHD的营养管理提供参考。方法 选取2021年1月—2023年12月嘉兴市妇幼保健院儿童保健门诊经盐酸哌甲酯治疗的321例6～12岁儿童为ADHD组，同期在该院健康体检的348例儿童为对照组。两组儿童在用药前后均进行维生素A和维生素D测定并通过多动障碍筛查量表(SNAP-Ⅳ)评估ADHD的症状。分析ADHD组和对照组研究对象维生素A和维生素D水平及不足情况，通过Spearman相关性分析ADHD症状与维生素A和维生素D水平的相关性。结果 两组研究对象性别、年龄比较，差异均无统计学意义(均P>0.05);用药前维生素A、维生素D不足和缺乏分布比较，差异均有统计学意义(均P<0.05)，且ADHD组中维生素A和维生素D不足占比分别为43.60%、24.90%，维生素A和维生素D缺乏占比分别为5.60%、4.40%，差异均有统计学意义(χ²=8.403、11.252，均P<0.05); ADHD组维生素A水平与对照组研究对象比较，差异无统计学意义(P>0.05)，维生素D水平低于对照组，差异有统计学意义(P<0.05)。给予盐酸哌甲酯，维生素A和维生素D制剂补充，饮食治疗6个月，用药后维生素A的水平较用药前提高，差异有统计学意义(Z=-3.396,P<0.05)，用药前后维生素D水平比较，差异无统计学意义(P>0.05)。注意缺陷为主型ADHD患儿的维生素A水平与注意缺陷症状程度呈负相关关系(r=-0.181,P<0.05)，多动为主型和混合型ADHD患儿的维生素D水平与注意缺陷症状程度呈负相关关系(r=-0.286,P<0.05)。结论 学龄期ADHD儿童的维生素A、维生素D不足和缺乏率高，维生素A、维生素D不足和缺乏同时影响ADHD的注意缺陷症状，应注意ADHD儿童维生素A、维生素D水平检测，随访中注意结合营养指导和制剂补充，以便取得更好的疗效。

Objective To analyze the correlation between vitamin A and vitamin D levels and attention deficit hyperactivity disorder(ADHD) symptoms in school-age children with ADHD before and after medication,and provide reference for nutritional management of ADHD. Methods A total of 321 children aged 6-12 years who were treated with methylphenidate hydrochloride in the Jiaxing Matenity and Child Health Care Hospital were enrolled as the ADHD group,and 348 children who underwent physical examination during the same period were enrolled as the control group. Vitamin A and vitamin D measurements were performed before and after treatment and ADHD symptoms were assessed by the Swanson,Nolan and Pelham Rating Scale(SNAP-Ⅳ). the levels and insufficiency of vitamin A and vitamin D in ADHID group and control group were analyzed,and the correlation between ADHD symptoms and vitamin A and vitamin D levels was analyzed by Spearman correlation analysis. Results There was no significant difference in gender and age between the two groups(all P >0. 05); the distribution of vitamin A and vitamin D deficiency and insufficiency before medication were compared,and the differences were statistically significant(all P<0. 05). The proportion of vitamin A and vitamin D insufficiency in ADHD group was 43. 60% and 24. 90%,and the proportion of vitamin A and vitamin D deficiency was 5. 60% and 4. 40%,respectively,with statistical significance(χ²= 8. 403,11. 252,all P<0. 05). There was no significant difference in vitamin A level between ADHD group and control group(P>0. 05),vitamin D level was lower than that of control group,and the difference was statistically significant(P<0. 05). The level of vitamin A was increased after receiving methylphenidate hydrochloride,vitamin A and vitamin D supplements,and diet treatment for 6 months,and the difference was statistically significant(Z =-3. 396,P < 0. 05). There was no significant difference in vitamin D levels before and after treatment(P >0. 05). The level of vitamin A in children with attention deficit-based ADHD was negatively correlated with the severity of attention-deficit symptoms(r =-0. 181,P<0. 05). And there was a negative correlation between vitamin D levels and the severity of attention deficit symptoms in children with impulsive-hyperactive-based and mixed attention deficit ADHD(r =-0. 286,P<0. 05). Conclusion Vitamin A and vitamin D insufficiency and deficiency rate are high in school-age children with ADHD,and the insufficiency and deficiency of vitamin A and vitamin D affect attention deficit symptoms of ADHD. Therefore,it was necessary to pay attention to the detection of vitamin A and vitamin D levels in children with ADHD,and nutritional guidance and vitamin A and vitamin D supplementation should be combined during follow-up to achieve better efficacy.