兒童過敏疾病與注意力不足過動症及對立反抗症之相關性

Abstract

背景：兒童過敏疾病(異位性皮膚炎、氣喘、過敏性鼻炎)與心理健康問題(注意力缺陷過動症、對立反抗症)之盛行率皆有增加的趨勢。近年有文獻支持兒童過敏疾病與心理健康問題的相關性。因此我們以橫斷法研究，希望了解台灣兒童的過敏疾病狀況及心理健康的關聯。 方法：自2010年起，台灣兒童健康研究（Taiwan Children Health Study）針對國小四年級學童收案追蹤。共有3246位學童參與2011年收案。我們彙集父母親評量及兒童自評結果，有2896位參與者資料進入分析。使用量表包含:注意力缺陷過動症(SNAP-IV 26)，流行病學研究中心憂鬱量表 (CES-D)，壓力知覺量表(PSS), 以及匹茲堡睡眠品質指標量表(PSQI)。 結果：曾被醫師診斷異位性皮膚炎有8.9%，近一年內有異位性皮膚炎症狀14.8%，曾醫師診斷氣喘9.7%，曾醫師診斷過敏性鼻炎31.6%，注意力缺陷過動症6.1%，而對立反抗症2.9%。近一年內有異位性皮膚炎症狀增加注意力缺陷過動症的機率，OR為1.64 (95%CI 1.12-2.40)。近一年內發生氣喘會增加對立反抗症的機率，OR為2.69 (95%CI 1.12-6.44) 。近一年內有過敏性鼻炎症狀會增加注意力缺陷過動症-混合亞型的機率，OR為2.11 (95%CI 1.25-3.53) 。 交互作用分析結果，憂鬱症狀對於氣喘之於對立反抗症之交互作用P=0.02, 有統計上顯著意義。氣喘且合併憂鬱傾向發生對立反抗症的機率，OR為 8.54 (95%CI 3.87-18.87) 感知壓力對於異位性皮膚炎之於注意力缺陷過動症與對立反抗症之交互作用,皆有統計上顯著意義。 睡眠品質問題對於氣喘之於對立反抗症之交互作用P=0.03, 亦有統計上顯著意義。氣喘且合併睡眠品質問題會加乘發生對立反抗症的機率，OR為 8.24 (95%CI 3.58-18.98) 結論：兒童過敏疾病之於注意力不集中過動症還有對立反抗症有相關。其中，以近一年內曾有皮膚炎症狀對注意力缺陷過動症影響最大。異位性皮膚炎有壓力症狀時容易增加注意力缺陷過動症及對立反抗症。壓力症狀是異位性皮膚炎與注意力不集中過動症以及對立反抗症的修飾因子(effect modifier)。氣喘患者有憂鬱症狀或是睡眠品質問題時容易出現對立反抗症。憂鬱症狀與睡眠品質是氣喘與對立反抗之間的修飾因子(effect modifier)。 兒童過敏疾病與心理健康的問題，可能藉由不同路徑互相影響。藉由疾病相關性的討論，更全面性的預防、衛教、與治療兒童健康問題將是未來方向。

Background： Mental health problems, like Attention-deficit/ hyperactivity disorder (ADHD) and Oppositional defiant disorder (ODD) had increasing prevalence among children, so did the allergic diseases (atopic dermatitis, asthma, and allergic rhinitis). Recently, there were literatures reporting the association of allergic diseases with ADHD. A cross-sectional study was held here to clarify the association. Material & Methods: The Taiwan Children Health Study (TCHS) is an ongoing cohort study. Fourth-grade children were enrolled from 14 diverse Taiwanese communities in 2010. We obtained 2896 subjects data in 2011. The questionnaires included: Swanson, Nolan and Pelham questionnaire (SNAP-IV 26), Center for Epidemiologic Studies Depression Scale (CES-D), Perceived Stress Scale (PSS), and Pittsburgh Sleep Quality Index (PSQI). Result: The overall prevalence of ever AD, asthma, and AR were 9.1%, 9.7% and 31.6% respectively. The symptom of AD, asthma, and AR within recent one year was 7.0%, 3.0%, and 19.9%. The prevalence of having symptom of ADHD was 6.1%, while the ADHD subtypes like ADHD-inattention, ADHD-hyperactivity, ADHD-combined were 3.0%, 4.6%, and 2.2% respectively, and the ODD was 2.9%. Children with AD within recent one year had higher risk to developed symptom of ADHD (OR 1.88, 95%CI 1.15-3.07), ADHD-inattention (OR 2.86, 95%CI 1.56-5.24) and ODD (OR 2.28, 95%CI 1.21-4.31). Children with asthma episode within recent one year had higher risk to developed symptom of ODD (OR 2.69, 95%CI 1 .12-6.44). AR within recent one year had higher risk to developed symptom of ADHD-inattention (OR 1.61, 95%CI 1.00-2.58) and ADHD-combined (OR 2.56, 95%CI 1 .52 to 4.31). The interaction analysis showed depression interacted with ever asthma toward symptom of ODD significantly (P=0.02). Children with asthma and depressive symptom had higher risk in ODD (OR 8.54, 95%CI 3 .87 to 18.87). Stress interacted with ever AD significantly toward symptom of ADHD, ADHD-hyperactivity impulsitivity, ADHD-combined and ODD (P=0.03, P=0.02, P=0.05, and P=0.008). Poor sleep quality interacted with ever asthma toward symptom of ODD significantly (P=0.03). Children with asthma and poor sleep quality had higher risk in ODD (OR 8.24, 95%CI 3 .58 to 18.98). Conclusion: Children with allergic disease, like AD, asthma, and allergic rhinitis may have higher risk to develop different subtypes of ADHD or ODD. The strongest association was noted in “AD within one year”. AD patients interacted with stress to develop symptoms of ADHD and ODD. Stress is an effect modifier between AD and ADHD. However, Asthma patients interacted with depression and poor sleep quality to developed symptoms of ODD. Depression and poor sleep quality are effect modifiers between asthma and ODD. We concluded that there were different pathways between allergic diseases and ADHD/ODD. A fulfill prevention, education, and treatment program composing by many specialists is the future trend.