维生素D联合DHA补充干预学龄前注意缺陷多动障碍的疗效研究

doi:10.3969/j.issn.1674-8115.2025.05.005

上海交通大学学报（医学版） ›› 2025, Vol. 45 ›› Issue (5): 570-577.doi: 10.3969/j.issn.1674-8115.2025.05.005

维生素D联合DHA补充干预学龄前注意缺陷多动障碍的疗效研究

张玥¹, 张丽珊², 丁肖媛³, 沈植旻¹, 卞邹吉¹, 余晓丹¹()

^1.上海交通大学医学院附属上海儿童医学中心发育行为儿科，上海 200127
^2.上海市浦东新区妇幼保健中心业务管理办公室，上海 201399
^3.上海市浦东新区人民医院儿科，上海 201299

收稿日期:2024-05-01 接受日期:2025-02-28 出版日期:2025-05-28 发布日期:2025-05-28
通讯作者: 余晓丹，主任医师，博士；电子信箱：xdyu1108@163.com.
作者简介:张　玥（1996—），女，住院医师，博士；电子信箱：13127715748@163.com。
基金资助:
国家重点研究发展计划重点专项(2022YFC2705203);上海交通大学医学院儿科学院注意缺陷多动障碍临床研究中心项目(ELYZX202207┫。基金项目:)

Therapeutic effect of combined vitamin D and DHA supplementation on preschool children with attention deficit hyperactivity disorder

ZHANG Yue¹, ZHANG Lishan², DING Xiaoyuan³, SHEN Zhimin¹, BIAN Zouji¹, YU Xiaodan¹()

^1.Department of Developmental Behavioral Pediatrics, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
^2.Business Management Office, Shanghai Pudong Center for Women and Children's Health, Shanghai 201399, China
^3.Department of Pediatrics, Shanghai Pudong New Area People's Hospital, Shanghai 201299, China

Received:2024-05-01 Accepted:2025-02-28 Online:2025-05-28 Published:2025-05-28
Contact: YU Xiaodan, E-mail: xdyu1108@163.com.
Supported by:
National Key Research and Development Program of China(2022YFC2705203);Clinical Research Center of Attention-Deficit Hyperactivity Disorder Affiliated with Pediatric College, Shanghai Jiao Tong University School of Medicine(ELYZX202207)

摘要/Abstract

摘要：

目的·探讨维生素D联合二十二碳六烯酸（docosahexaenoic acid，DHA）补充对学龄前注意缺陷多动障碍（attention deficit hyperactivity disorder，ADHD）患儿的治疗作用。方法·2021年4月—5月，以分层整群随机抽样法抽取上海市浦东新区塘桥街道、川沙镇及合庆镇共8所幼儿园1 412名4~6岁学龄前儿童，采用Conner′s量表、美国《精神障碍诊断与统计手册（第5版）》（Diagnosis and Statistical Manual of Mental Disorders，fifth edition，DSM-Ⅴ）及Swanson、Nolan和Pelham等开发的父母及教师评定量表（Swanson，Nolan，and Pelham Scale，version Ⅳ，SNAP-Ⅳ量表）评估儿童注意力及多动症状，通过韦氏儿童智力测验排除其他神经发育性障碍。入组82例ADHD学龄前儿童，充分告知干预措施后，依据家长意愿分为营养干预组（n=64）与对照组（n=18）。对照组接受行为常规宣教；营养干预组在此基础上，每天补充维生素D 800 IU、DHA 400 mg。分别于入组时、3个月和12个月随访时采集静脉血，检测血清25羟维生素D［25（OH）D］及DHA水平，采用Conner′s量表、SNAP-Ⅳ量表及DSM-Ⅴ评估ADHD核心症状。结果·营养干预组3个月及12个月随访时，血清25（OH）D和DHA水平与干预前相比，均显著升高（均P<0.05）；营养干预组3个月及12个月随访时的ADHD核心症状评分，包括Conner′s量表冲动-多动评分及多动指数评分、SNAP-Ⅳ量表注意力评分及多动/冲动评分、DSM-Ⅴ注意缺陷评分及多动/冲动评分，与干预前相比均显著降低（均P<0.05）。对照组3个月及12个月随访时血清25（OH）D及DHA水平、ADHD核心症状评分与入组时比较，差异均无统计学意义。3个月随访时，营养干预组SNAP-Ⅳ量表及DSM-Ⅴ的多动/冲动评分均较对照组显著改善（均P<0.05）；12个月随访时，营养干预组Conner′s量表中的品行问题、冲动-多动评分及多动指数评分，SNAP-Ⅳ量表和DSM-Ⅴ中的多动/冲动评分均较对照组显著改善（均P<0.05）。结论·维生素D联合DHA营养干预可显著提高学龄前ADHD患儿的血清25（OH）D和DHA水平，及改善ADHD核心症状。

关键词: 注意缺陷多动障碍, 学龄前, 维生素D, 二十二碳六烯酸

Abstract:

Objective ·To investigate the therapeutic effect of combined vitamin D and docosahexaenoic acid (DHA) supplementation on preschool children with attention deficit hyperactivity disorder (ADHD). Methods ·From April 2021 to May 2021, a total of 1 412 children aged 4 to 6 years from eight kindergartens in Pudong New Area of Shanghai, including Tangqiao Street, Chuansha Town, and Heqing Town, were randomly selected by stratified cluster random sampling method. Attention and hyperactivity symptom assessment was performed using the Conner′s Scale, Diagnosis and Statistical Manual of Mental Disorders(fifth edition, DSM-Ⅴ), and Swanson, Nolan, and Pelham (version Ⅳ, SNAP-Ⅳ) Scale, and other neurodevelopmental disorders were excluded using the Wechsler Intelligence Scale. A total of 82 preschool children with ADHD were enrolled, and after fully informing them of the intervention measures, they were divided into an intervention group (n=64) and a control group (n=18) based on their parents′ choice. The control group received routine health education. In addition to routine health education, the intervention group received daily supplementation of Vitamin D (800 IU) and DHA (400 mg). Venous blood samples were collected from both groups at baseline, 3 months, and 12 months for the measurement of serum 25 hydroxy vitamin D [25 (OH) D] and DHA levels. ADHD symptoms were evaluated using Conner′s Scale, SNAP-Ⅳ Scale, and DSM-Ⅴ. Results ·After 3 and 12 months of intervention in the intervention group, serum 25 (OH) D levels and DHA levels were significantly higher (P<0.05), the ADHD symptom scores, including impulsivity-hyperactivity and hyperactivity index scores in Conner′s Scale, the attention and hyperactivity/impulsivity scores in SNAP-Ⅳ Scale, and the attention and hyperactivity/impulsivity scores in DSM-Ⅴ, were significantly reduced compared with the scores before the intervention (P<0.05). There was no significant difference in serum 25 (OH) D and DHA levels, or ADHD symptom scores, at the 3- and 12-month follow-ups compared to baseline. After 3 months of nutritional intervention in the intervention group, the hyperactivity/impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ were significantly improved compared to the control group (P<0.05). After 12 months of intervention, conduct problems, impulsive-hyperactivity and hyperactivity index scores in Conner′s Scale, and hyperactivity/ impulsivity scores in SNAP-Ⅳ Scale and DSM-Ⅴ showed significant improvement compared to the control group (P<0.05). Conclusion ·Combined supplementation with vitamin D and DHA significantly improves serum 25 (OH) D and DHA levels and alleviates ADHD symptoms in preschool children.

Key words: attention deficit hyperactivity disorder, preschool, vitamin D, docosahexaenoic acid

中图分类号:

R749.94

张玥, 张丽珊, 丁肖媛, 沈植旻, 卞邹吉, 余晓丹. 维生素D联合DHA补充干预学龄前注意缺陷多动障碍的疗效研究[J]. 上海交通大学学报（医学版）, 2025, 45(5): 570-577.

ZHANG Yue, ZHANG Lishan, DING Xiaoyuan, SHEN Zhimin, BIAN Zouji, YU Xiaodan. Therapeutic effect of combined vitamin D and DHA supplementation on preschool children with attention deficit hyperactivity disorder[J]. Journal of Shanghai Jiao Tong University (Medical Science), 2025, 45(5): 570-577.

图/表 2

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Item	Total (n=82)	Nutrition intervention group (n=64)	Control group (n=18)	t /χ² value	P value
Gender/n (%)				0.46	0.527
Male	64 (78.05)	51 (79.69)	13 (72.22)
Female	18 (21.95)	13 (20.31)	5 (27.78)
Age/year	5.23±0.81	5.25±0.75	5.17±0.96	0.30	0.768
IQ/score	119.56±13.80	120.81±14.87	116.75±11.10	0.85	0.403
Maternal age/year	33.00±3.33	33.05±3.47	32.93±3.26	0.10	0.920
Paternal age/year	34.29±3.76	34.60±3.26	33.87±3.72	0.57	0.576
Maternal education level/n (%)				1.29	0.525
High school degree	9 (10.98)	6 (9.38)	3 (16.67)
College degree	45 (54.88)	37 (57.81)	8 (44.44)
Bachelor degree or above	28 (34.14)	21 (32.81)	7 (38.89)
Paternal education level/n (%)				0.51	0.776
High school degree	5 (6.10)	4 (6.25)	1 (5.56)
College degree	42 (51.22)	34 (53.13)	8 (44.44)
Bachelor degree or above	35 (42.68)	26 (40.62)	9 (50.00)
Annual household income/n (%)				1.06	0.588
<300 000 yuan	10 (12.19)	9 (14.06)	1 (5.56)
300 000‒500 000 yuan	65 (79.27)	50 (78.13)	15 (83.33)
>500 000 yuan	7 (8.54)	5 (7.81)	2 (11.11)
25(OH)D/(ng·mL^-1)	26.73±4.93	24.42±3.46	27.97±5.88	-0.16	0.874
Vitamin D status/n (%)				0.50	0.779
Deficiency	6 (7.32)	4 (6.25)	2 (11.11)
Insufficient	53 (64.63)	42 (65.63)	11 (61.11)
Sufficient	23 (28.05)	18 (28.12)	5 (27.78)
DHA/(nmol·mL^-1)	159.83±45.89	156.54±42.37	173.47±85.64	-1.62	0.114

Item	Total (n=82)	Nutrition intervention group (n=64)	Control group (n=18)	t /χ² value	P value
Gender/n (%)				0.46	0.527
Male	64 (78.05)	51 (79.69)	13 (72.22)
Female	18 (21.95)	13 (20.31)	5 (27.78)
Age/year	5.23±0.81	5.25±0.75	5.17±0.96	0.30	0.768
IQ/score	119.56±13.80	120.81±14.87	116.75±11.10	0.85	0.403
Maternal age/year	33.00±3.33	33.05±3.47	32.93±3.26	0.10	0.920
Paternal age/year	34.29±3.76	34.60±3.26	33.87±3.72	0.57	0.576
Maternal education level/n (%)				1.29	0.525
High school degree	9 (10.98)	6 (9.38)	3 (16.67)
College degree	45 (54.88)	37 (57.81)	8 (44.44)
Bachelor degree or above	28 (34.14)	21 (32.81)	7 (38.89)
Paternal education level/n (%)				0.51	0.776
High school degree	5 (6.10)	4 (6.25)	1 (5.56)
College degree	42 (51.22)	34 (53.13)	8 (44.44)
Bachelor degree or above	35 (42.68)	26 (40.62)	9 (50.00)
Annual household income/n (%)				1.06	0.588
<300 000 yuan	10 (12.19)	9 (14.06)	1 (5.56)
300 000‒500 000 yuan	65 (79.27)	50 (78.13)	15 (83.33)
>500 000 yuan	7 (8.54)	5 (7.81)	2 (11.11)
25(OH)D/(ng·mL^-1)	26.73±4.93	24.42±3.46	27.97±5.88	-0.16	0.874
Vitamin D status/n (%)				0.50	0.779
Deficiency	6 (7.32)	4 (6.25)	2 (11.11)
Insufficient	53 (64.63)	42 (65.63)	11 (61.11)
Sufficient	23 (28.05)	18 (28.12)	5 (27.78)
DHA/(nmol·mL^-1)	159.83±45.89	156.54±42.37	173.47±85.64	-1.62	0.114

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维生素D联合DHA补充干预学龄前注意缺陷多动障碍的疗效研究

Therapeutic effect of combined vitamin D and DHA supplementation on preschool children with attention deficit hyperactivity disorder

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