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。

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.