| Objective:To investigate the prevalence and related factors of attention deficit hyperactivity disorder(ADHD)in children with adenoidal hypertrophy(AH),and to explore its correlation with peripheral serum orexins level,so as to provide evidence and potential serum markers for the prevention and treatment of AH combined with ADHD.Methods:In this study,122 children with AH aged 6-13 years diagnosed by the Department of Otolaryngology of the Second Hospital of Jilin University were included as the observation group.At the same time,83 healthy children with the matching age and gender from Outpatient Department of Pediatric of the same hospital were included as the control group.A questionnaire including general conditions and ADHD rating scale was used to investigate the prevalence and related information of ADHD in the two groups of children,and then the investigation results were analyzed and the influencing factors of AH combined with ADHD were explored.According to the survey results,children with AH were divided into AH with ADHD group(case group)and AH without ADHD group(case control group).According to the clinical manifestations of ADHD,the children in the case group were divided into group A(attention deficit type),group B(hyperactive impulse type)and group C(mixed type).Using the case-control group method,30 cases were randomly selected from the case group,case control group,and healthy control group(children without AH or ADHD),respectively.The serum orexin A and B levels were detected by enzyme-linked immunosorbent assay(ELISA),and the differences in the peripheral blood orexin levels of the three groups of children were compared.The data were statistically analyzed using SPSS 26.0 software.Results:The study showed that:(1)The prevalence of ADHD in AH children was 36.89%(45/122),which was higher than 7.22%(6/83)in healthy children(P<0.001).(2)There was no significant difference in the prevalence of ADHD between the observation group and the control group of children of different ages(all P>0.05).(3)The prevalence of ADHD among children in the severe group of AH(48.89%)was higher than that of children in the mild group(29.87%)(P=0.036).(4)Among the different courses of AH,the prevalence of ADHD(71.43% and44.07%,respectively)of children in the group of disease course>3 years and the group of 1 to 3 years was higher than that of children in the group of disease course less than 1 year(18.37%)(P<0.001).(5)Univariate analysis showed,there were statistical differences between the case group and the case control group in the course of AH,AH grading,time of vitamin D supplementation,parental personality,maternal educational level,family education style,and maternal smoking or passive smoking during pregnancy(all P<0.05).(6)Binary Logistic regression analysis showed that the long course of AH,high AH score and smoking or passive smoking during pregnancy were the risk factors for ADHD(OR=1.050,95%CI: 1.020-1.079;OR=3.835,95%CI : 1.235-11.907;OR=13.003,95%CI: 1.109-152.512,all P<0.05);Vitamin D supplementation time > 3 years,parents with moderate personality and encouraging education were the protective factors for ADHD(OR= 0.127,95%CI: 0.026-0.631;OR=0.194,95%CI: 0.052-0.730;OR=0.094,95%CI: 0.015-0.586,all P<0.05).(7)Serum orexin level: Orexin A level of the case group [(13.68±4.10)ng/ml] was lower than that of the case control group [(16.04±3.17)ng/ml] and the healthy control group [(19.05±3.66))ng/ml](P=0.044,P<0.001 respectively).Orexin A level of the case control group [(16.04 ± 3.17)ng/ml] was lower than that of the healthy control group [(19.05±3.66)ng/ml](P=0.006).Serum orexin A concentration were negatively correlated with SNAP-IV score(r=-0.515,P=0.004);Orexin B level of the case group [(11.88±3.38)ng/ml] was lower than that of the healthy control group [(15.09 ± 4.06)ng/ml](P=0.007),and Orexin B level of the case control group [(11.89±4.39)ng/ml] was lower than that of the healthy control group [(15.09 ±4.06)ng/ml](P=0.007).There was no significant difference in serum orexin B levels between the case group and the case control group(P=1.000).There was no correlation between serum orexin B concentration and SNAP-IV score(r=-0.245,P=0.192).There was no significant difference in the level of orexin A among different ADHD subgroups(all P>0.05).Conclusions:1.The prevalence of ADHD in AH children was significantly higher than that in normal children;the prevalence of ADHD in children with severe AH was higher than that in children with mild AH;the prevalence of ADHD in the children with longer AH course was higher than that in the short course group.The family and medical staff should pay attention to the prevention and treatment of ADHD in AH children.2.Actively treating AH,creating a good family atmosphere,avoiding smoking or passive smoking during pregnancy,giving appropriate education methods and actively supplementing vitamin D can help prevent AH children from being combined with ADHD.3.The serum orexin A concentration were negatively correlated with the scores of ADHD symptoms in children with AH.Orexin A could be used as a candidate serological indicator of ADHD in AH children. |
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