注意缺陷多动障碍发病机制研究进展

Research advances in pathogenesis of attention deficit hyperactivity disorder

摘要:

遗传和环境因素在注意缺陷多动障碍（ADHD）的发病中占有重要作用，其中遗传因素可增加个体对环境危险因素的敏感性。ADHD患者存在广泛及多样的大脑结构及功能异常，鉴于各脑区功能的紧密联系，近年来探究的视角也扩大到大脑网络功能的障碍。在导致ADHD的生化机制方面，最被重视的依然是单胺类化合物，近年来发现还可能伴随有脑源性神经营养因子及谷氨酸/γ-氨基丁酸平衡的异常。基因和环境因素协同造成神经内分泌及脑区间联系的异常，使前额叶失去对下级脑区的控制；失去有效调控的基底神经节、杏仁核等影响行为和情绪反应，内分泌调节轴的紊乱则进一步加重神经内分泌异常，长此以往造成大脑结构和功能的改变可能同ADHD的发病相关。但鉴于ADHD的异质性，其病理过程可能不尽相同，具体的机制尚待进一步的研究阐明。

Abstract:

Both of genetic and environmental factors play important roles in the pathogenesis of attention deficit hyperactivity disorder (ADHD), and genetic factors can increase the susceptibility of individuals to environmental risk factors. There are extensive and various structural and functional abnormalities of the brain in patients with ADHD. Given the close functional relationship between brain areas, exploration has also been expanded to the dysfunction of brain network in recent years. As for the biochemical mechanism underlying ADHD, monoamine neurotransmitters are still most valued, and abnormalities of brain-derived neurotrophic factors and glutamic acid/γ-aminobutyric acid imbalance may also be present. Due to the abnormal neuroendocrine function and connectivity between brain areas caused by the synergistic effect of genetic and environmental factors, the prefrontal cortex loses control of the lower brain areas, so that the basal ganglia and amygdala affect normal behavioral and emotional reactions. Dysfunction of the endocrine axes may further aggravate neuroendocrine disorder. The above process may eventually lead to changes in brain structure and function, which may be associated with the development of ADHD. However, considering the heterogeneity of ADHD, its pathological process may not be the same, and the exact mechanism needs to be further clarified.