注意力不足過動症的病因學：修订间差异

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* 睡眠品質低落、睡眠障礙、[[睡眠呼吸中止症]]<ref name="Leng McEvoy Allen Yaffe p. ">
* 睡眠品質低落、睡眠障礙、[[睡眠呼吸中止症]]<ref name="Leng McEvoy Allen Yaffe p. ">
{{cite journal | last=Leng | first=Yue | last2=McEvoy | first2=Claire T. | last3=Allen | first3=Isabel E. | last4=Yaffe | first4=Kristine | title=Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment | journal=JAMA Neurology | publisher=American Medical Association (AMA) | date=2017-08-28 | issn=2168-6149 | doi=10.1001/jamaneurol.2017.2180 | page= | type=systematic review | url=http://jamanetwork.com/journals/jamaneurology/article-abstract/2649259 | deadurl=no | archiveurl=https://web.archive.org/web/20170830104522/http://jamanetwork.com/journals/jamaneurology/article-abstract/2649259 | archivedate=2017-08-30 }}</ref>
{{cite journal | last=Leng | first=Yue | last2=McEvoy | first2=Claire T. | last3=Allen | first3=Isabel E. | last4=Yaffe | first4=Kristine | title=Association of Sleep-Disordered Breathing With Cognitive Function and Risk of Cognitive Impairment | journal=JAMA Neurology | publisher=American Medical Association (AMA) | date=2017-08-28 | issn=2168-6149 | doi=10.1001/jamaneurol.2017.2180 | page= | type=systematic review | url=http://jamanetwork.com/journals/jamaneurology/article-abstract/2649259 | deadurl=no | archiveurl=https://web.archive.org/web/20170830104522/http://jamanetwork.com/journals/jamaneurology/article-abstract/2649259 | archivedate=2017-08-30 }}</ref>
* {{tsl|en|Cerebral hypoxia|腦部缺氧}}<ref name="UpToDate regarding cardiac output">{{cite web | title=Indications and hemoglobin thresholds for red blood cell transfusion in the adult | website=[[UpToDate]] | url=https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-red-blood-cell-transfusion-in-the-adult?search=blood%20transfusion&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2 | access-date=2018-02-17 | deadurl=no | archiveurl=https://web.archive.org/web/20180217202824/https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-red-blood-cell-transfusion-in-the-adult?search=blood%20transfusion&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2 | archivedate=2018-02-17 }}</ref>：可能造成腦部缺氧的常見可能因素（僅列出呼吸道過敏相關）<ref name="Miyazaki Koyama Ota Swa p. ">{{cite journal | last=Miyazaki | first=Celine | last2=Koyama | first2=Momoko | last3=Ota | first3=Erika | last4=Swa | first4=Toshiyuki | last5=Mlunde | first5=Linda B. | last6=Amiya | first6=Rachel M. | last7=Tachibana | first7=Yoshiyuki | last8=Yamamoto-Hanada | first8=Kiwako | last9=Mori | first9=Rintaro | title=Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis | journal=BMC psychiatry | publisher=Springer Nature | volume=17 | issue=1 | date=2017-03-31 | issn=1471-244X | pmid=28359274 | pmc=5374627 | doi=10.1186/s12888-017-1281-7 | page= | quote=The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, [[異位性皮膚炎|atopic dermatitis]], and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial.}}</ref>：
* {{tsl|en|Cerebral hypoxia|腦部缺氧}}<ref name="UpToDate regarding cardiac output">{{cite web | title=Indications and hemoglobin thresholds for red blood cell transfusion in the adult | website=[[UpToDate]] | url=https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-red-blood-cell-transfusion-in-the-adult?search=blood%20transfusion&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2 | access-date=2018-02-17 | deadurl=no | archiveurl=https://web.archive.org/web/20180217202824/https://www.uptodate.com/contents/indications-and-hemoglobin-thresholds-for-red-blood-cell-transfusion-in-the-adult?search=blood%20transfusion&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1#H2 | archivedate=2018-02-17 }}</ref>：可能造成腦部缺氧的常見可能因素（僅列出[[呼吸道]]過敏與[[血液學]]相關的項目）<ref name="Miyazaki Koyama Ota Swa p. ">{{cite journal | last=Miyazaki | first=Celine | last2=Koyama | first2=Momoko | last3=Ota | first3=Erika | last4=Swa | first4=Toshiyuki | last5=Mlunde | first5=Linda B. | last6=Amiya | first6=Rachel M. | last7=Tachibana | first7=Yoshiyuki | last8=Yamamoto-Hanada | first8=Kiwako | last9=Mori | first9=Rintaro | title=Allergic diseases in children with attention deficit hyperactivity disorder: a systematic review and meta-analysis | journal=BMC psychiatry | publisher=Springer Nature | volume=17 | issue=1 | date=2017-03-31 | issn=1471-244X | pmid=28359274 | pmc=5374627 | doi=10.1186/s12888-017-1281-7 | page= | quote=The findings from this review and meta-analysis show that children with ADHD are more likely to have asthma, allergic rhinitis, [[異位性皮膚炎|atopic dermatitis]], and allergic conjunctivitis than their counterparts. Interventions including strategies for managing allergies in children with ADHD would be beneficial.}}</ref>：
:* [[鼻息肉]]肥厚、[[鼻塞]]、[[過敏性鼻炎]] <ref>{{cite journal | vauthors = Quillen DM, Feller DB | title = Diagnosing rhinitis: allergic vs. nonallergic | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1583–90 | date = May 2006 | pmid = 16719251 }}</ref><ref name="pmid10795648">{{cite journal | vauthors = Marshall PS, O'Hara C, Steinberg P | title = Effects of seasonal allergic rhinitis on selected cognitive abilities | journal = Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology | volume = 84 | issue = 4 | pages = 403–10 | date = April 2000 | pmid = 10795648 | doi = 10.1016/S1081-1206(10)62273-9 }}</ref><ref name="Wang Yu Fu Yeh p. "/><ref name="respiratory tract">{{cite web |url=http://care.american-rhinologic.org/septoplasty_turbinates |title=Septoplasty & Turbinate Surgery Parul Goyal, Md, Mba |publisher=Care.american-rhinologic.org |date=2015-02-17 |accessdate=2016-12-27 |deadurl=no |archiveurl=https://web.archive.org/web/20161214144554/http://care.american-rhinologic.org/septoplasty_turbinates |archivedate=2016-12-14 }}</ref><ref name="Yang Yang Wang 2018 pp. 277–283">{{cite journal | last=Yang | first=Chia-Feng | last2=Yang | first2=Chen-Chang | last3=Wang | first3=I-Jen | title=Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study | journal=Journal of the Chinese Medical Association : JCMA | publisher=Elsevier BV | volume=81 | issue=3 | year=2018 | issn=1726-4901 | pmid=29239851 | doi=10.1016/j.jcma.2017.07.016 | pages=277–283}}</ref>
:* [[鼻息肉]]肥厚、[[鼻塞]]、[[過敏性鼻炎]] <ref>{{cite journal | vauthors = Quillen DM, Feller DB | title = Diagnosing rhinitis: allergic vs. nonallergic | journal = American Family Physician | volume = 73 | issue = 9 | pages = 1583–90 | date = May 2006 | pmid = 16719251 }}</ref><ref name="pmid10795648">{{cite journal | vauthors = Marshall PS, O'Hara C, Steinberg P | title = Effects of seasonal allergic rhinitis on selected cognitive abilities | journal = Annals of Allergy, Asthma & Immunology : Official Publication of the American College of Allergy, Asthma, & Immunology | volume = 84 | issue = 4 | pages = 403–10 | date = April 2000 | pmid = 10795648 | doi = 10.1016/S1081-1206(10)62273-9 }}</ref><ref name="Wang Yu Fu Yeh p. "/><ref name="respiratory tract">{{cite web |url=http://care.american-rhinologic.org/septoplasty_turbinates |title=Septoplasty & Turbinate Surgery Parul Goyal, Md, Mba |publisher=Care.american-rhinologic.org |date=2015-02-17 |accessdate=2016-12-27 |deadurl=no |archiveurl=https://web.archive.org/web/20161214144554/http://care.american-rhinologic.org/septoplasty_turbinates |archivedate=2016-12-14 }}</ref><ref name="Yang Yang Wang 2018 pp. 277–283">{{cite journal | last=Yang | first=Chia-Feng | last2=Yang | first2=Chen-Chang | last3=Wang | first3=I-Jen | title=Association between allergic diseases, allergic sensitization and attention-deficit/hyperactivity disorder in children: A large-scale, population-based study | journal=Journal of the Chinese Medical Association : JCMA | publisher=Elsevier BV | volume=81 | issue=3 | year=2018 | issn=1726-4901 | pmid=29239851 | doi=10.1016/j.jcma.2017.07.016 | pages=277–283}}</ref>
:* {{tsl|en|Nasal septum deviation|鼻中隔彎曲}} <ref name="respiratory tract"/>
:* {{tsl|en|Nasal septum deviation|鼻中隔彎曲}} <ref name="respiratory tract"/>
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:**許多[[異位性皮膚炎]]患者也會同時有氣喘及[[過敏性鼻炎]]等問題<ref name="Lin Chen Gau Yeh 2016 pp. 480–485"/><ref name=NIH2013>{{cite web|title=Handout on Health: Atopic Dermatitis (A type of eczema)|url=http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|accessdate=2015-06-19|date=May 2013|deadurl=no|archiveurl=https://web.archive.org/web/20150530092344/http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|archivedate=2015-05-30}}</ref>
:**許多[[異位性皮膚炎]]患者也會同時有氣喘及[[過敏性鼻炎]]等問題<ref name="Lin Chen Gau Yeh 2016 pp. 480–485"/><ref name=NIH2013>{{cite web|title=Handout on Health: Atopic Dermatitis (A type of eczema)|url=http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|website=National Institute of Arthritis and Musculoskeletal and Skin Diseases|accessdate=2015-06-19|date=May 2013|deadurl=no|archiveurl=https://web.archive.org/web/20150530092344/http://www.niams.nih.gov/Health_Info/Atopic_Dermatitis/default.asp|archivedate=2015-05-30}}</ref>
:**[[变应性结膜炎]]也常出現於有過敏體質合併ADHD的人身上<ref name="Miyazaki Koyama Ota Swa p. "/>。
:**[[变应性结膜炎]]也常出現於有過敏體質合併ADHD的人身上<ref name="Miyazaki Koyama Ota Swa p. "/>。
:**[[血液]]異常<ref name="Pivina Semenova Doşa Dauletyarova 2019 pp. 1–10">{{cite journal | last=Pivina | first=Lyudmila | last2=Semenova | first2=Yuliya | last3=Doşa | first3=Monica Daniela | last4=Dauletyarova | first4=Marzhan | last5=Bjørklund | first5=Geir | title=Iron Deficiency, Cognitive Functions, and Neurobehavioral Disorders in Children | journal=Journal of molecular neuroscience : MN | publisher=Springer Nature | volume=68 | issue=1 | date=2019-02-18 | issn=0895-8696 | pmid=30778834 | doi=10.1007/s12031-019-01276-1 | pages=1–10}}</ref>。


* [[頭部受傷]]
* [[頭部受傷]]

2019年8月23日 (五) 08:57的版本

维基百科中的醫學内容仅供参考，並不能視作專業意見。如需獲取醫療幫助或意見，请咨询专业人士。詳見醫學聲明。
ADHD患者的腦部與非 ADHD患者（Typically developing controls）的腦部造影顯示的大腦發育成熟度的差異[1][2]。

關於注意力不足過動症的病因，絕大多數注意力不足過動症（ADHD）的確切成因目前並沒有定論，ADHD最有可能是基因、環境和社會等因素交互作用導致。[3][4][5][6]有些個案的成因可能與腦部的疾病感染和腦部創傷有關。[3][4][5]根據研究統計，注意力不足過動症具有相當高的遺傳率。[3][4]

利用核磁共振成像技術（MRI）對腦部掃描的研究顯示患有ADHD和正常孩子的圖象有分別。不少科學家認為這足以證明ADHD是和腦部創傷有關。但腦部影像只說明了作為腦內燃料的葡萄糖的分佈。在成人ADHD患者的腦掃描中，控制專注力的部份由於葡萄糖水平較低，所以顯得不太活躍。不過，沒有證據顯示低葡萄糖水平與低注意力有關連，亦無法推論兩者之間的因果關係。[7]

基因遺傳

“研究顯示ADHD會在家族中出現，所以有一定程度的遺傳影響。ADHD的病童通常都至少有一位近親亦有ADHD。患有ADHD的男童長大成為父親後，子女亦是ADHD患者的機率超過三分之一。一個更有說服力的遺傳聯繫，就是同卵雙生兒（雙胞胎），如果診斷出當中一位為ADHD患者，另一位同時亦是患者的機會非常高。”[8][9]
  1. 爸爸有「注意力不足過動症」，孩子有「注意力不足過動症」的比例（15%至45%）略高於媽媽有「注意力不足過動症」，孩子有「注意力不足過動症」的比例（14%至38%）[3]。
  2. ADHD神經心理學研究發現，在ADHD的親兄弟姊妹沒有確診為ADHD的前提下，ADHD孩童的親手足與一般孩童相比，依然容易出現執行功能 (如：空間工作記憶、視覺記憶[10]及持續專注力、時間估算[11]、反應時間變異[12]) 的缺損，ADHD患者的親兄弟姊妹出現類似上述問題的機率顯著較高，是一般正常孩子的3、4倍，稱為ADHD的認知內表現型（英语：endophenotype）（具有基因關係但未達診斷標準的症狀/特徵型）。[13][14][15][16][17]而當自己的親生兄弟姊妹之一確診是ADHD時，則自己也有ADHD的機率為25%至35%。[18][19][20][21][22]

更進一步來說，雙胞胎研究顯示ADHD通常遺傳自患者的父母。大約75%的患者的病因是基因因素。[23][24][25]
兒童青少年的手足（兄弟姊妹）比起非ADHD患者的手足多上三到四倍的機率帶有ADHD的特徵或也有ADHD。[26]基因可能也與注意力不足過動症是否從幼兒延續至成人有關聯。[27]

在一般的情況下，ADHD大多與數個影響多巴胺（大腦內一種神經傳導物質）傳遞的基因有關[28][29]。這些基因分別是 多巴胺輸送元（再攝取）DAT、多巴胺受体D4（DRD4）、多巴胺受體D5 (DRD5)（英语：DRD5）、TAAR1（英语：TAAR1）、MAOA（英语：MAOA）、兒茶酚-O-甲基轉移酶（COMT）、和多巴胺β羟化酶（DBH）。[29][30][31]

其他基因分別是血清素輸送元（SERT）、HTR1B（英语：HTR1B）、SNAP25（英语：SNAP25）、GRIN2A（英语：GRIN2A）、 ADRA2A（英语：ADRA2A）、TPH2（英语：TPH2）、和 腦源性神經營養因子（BDNF）[28][29]。

大約9%的ADHD患者身上會有LPN3（英语：LPN3）基因的變異體。而這些患者可能會對於中樞神經刺激劑特別有反應[32]。

多巴胺輸送元多巴胺受体D4（DRD4）的七個重複存在的變異體DRD4-7R與ADHD有關。因為它放大了由多巴胺觸發的抑制效果。DRD4的接收元是一個G蛋白偶聯受體，作用是抑制腺苷酸環化酶。DRD4的突變反映在許多行為表現上，包括ADHD的症狀群，例如：斷斷續續的注意力、分心。[33]

演化可能在ADHD的盛行率中扮演一定的角色，特別是有過動-衝動症狀的男性患者。[34]

唐氏症患者可能有較高的機率出現ADHD。[39]

2018年六月，《科學》期刊發表一篇統合分析初步發現，ADHD和躁鬱症、憂鬱症、和思覺失調症有許多共同的可能致病基因。[40]

環境因素

圖為一位孕婦的週期性腹部超音波成像。研究指出，母親在懷孕期間、兒童在出生時或成長初期遭受特定的感染都可能提高致病率。[41]

除了基因外，一些環境因子也可能是注意力不足過動症的致病因素。[42]例如：在懷孕期間攝取酒精可能導致包含類似注意力不足過動症症狀的胎兒酒精譜系障礙。暴露在特定有毒物質，例如：鉛或多氯聯苯等，可能會產生類似注意力不足過動症的中毒症狀。[43]暴露在磷酸酯的殺蟲劑、毒死蜱（一種晶體有機磷殺蟲劑）、烷基磷酸酯（英语：Alkyl phosphate）、二烷基磷酸酯中，將提高致病率，不過此結論尚未受到學界的廣泛認可。[44]在懷孕過程中接觸到二手煙，將不利於胚胎的腦部神經發育，並將增加罹患注意力不足過動症的機率。[45][46]

新生兒嚴重早產、新生兒體重過輕、兒童極端疏於照料（英语：neglect）、遭受凌虐、嚴重地缺乏與社會的互動（英语：Social_deprivation），也可能增加往後出現注意力不足過動症的機率。[45][47]

母親在懷孕期間、兒童在出生時或成長初期遭受特定的感染都可能提高致病率。這些特定的感染包含：麻疹、 varicella zoster病毒（英语：Varicella zoster virus）引起的腦炎、 風疹、第71型腸病毒（EV71）。[41]

一份於2017年11月美國小兒科學會（英语：American Academy of Pediatrics）發表的研究顯示，長時間於妊娠期間使用对乙酰氨基酚與孩子出生後帶有ADHD，有統計上的相關性。[註 1] [48][49]

另一份於2018年5月在美国医学会杂志發表的研究顯示，懷孕期間接觸己烯雌酚可能會使孫子（女）、外孫（女）增加帶有ADHD的機率。[50][51]

曾遭受外傷性腦損傷（英语：traumatic brain injury）（TBI）[a][註 2]的兒童[52]，其中至少30%將在往後的人生中發展出注意力不足過動症[53]。因外力而導致腦部受損而致注意力不足過動症大約占所有注意力不足過動症個案的5%。[54]

截至2019年7月，現有的證據無法支持減少食用特定食物（例如人工食用色素）來治療注意力不足過動症的療法[55]。

截至2019年7月，研究並不支持注意力不足過動症是因為攝取過多的精緻糖、看太多電視、貧窮或混亂、時局或所在環境的動盪不安、教養方式（英语：parenting）、吵吵鬧鬧的家庭所致。然而前述的這些項目可能會惡化一些注意力不足過動症患者的注意力不足過動症症狀。[56]

更多信息：空氣汙染 § 對中樞神經系統的影響、注意力不足過動症的治療 § 飲食和飲食與注意力不足過動症的關係

社會因素

被診斷為注意力不足過動症，不一定是受診者自身的問題，可能代表家庭功能不彰以及教育體制的僵化。[57] 曾遭受過暴力或精神虐待（心理虐待、情緒霸凌）的兒童相較於未曾有類似經驗的兒童，有較高的比例出現注意力不足過動症的行為。 [58]

澳洲官方統計發現低收入家庭的ADHD盛行率多於高收入的家庭、ADHD在單親家庭及繼母繼父家庭（英语：blended family）的盛行率高於普通常見的原生家庭結構。然而這些因素不被認為是導致ADHD的原因；相反地，它們被認為是ADHD和「患者周遭環境」產生交互作用後所導致的後果。 [59][60][61]

鑑別診斷

以下疾病可能造成類似注意力不足過動症的相關症狀表現（鑑別診斷）[62][63][64]：

備註

  1. ^ 參見：因果關係
  2. ^ *

注释

  1. ^ traumatic brain injury 也稱為「創傷性腦損傷」

文獻來源

  1. ^ Maturation of the brain, as reflected in the age at which a cortex area attains peak thickness, in ADHD (above) and normal development (below). Lighter areas are thinner, darker areas thicker. Light blue in the ADHD sequence corresponds to the same thickness as light purple in the normal development sequence. The darkest areas in the lower part of the brain, which are not associated with ADHD, had either already peaked in thickness by the start of the study, or, for statistical reasons, were not amenable to defining an age of peak cortex thickness. Movie of same data below. Source: NIMH Child Psychiatry Branch
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