vspВопросы современной педиатрииCurrent Pediatrics1682-55271682-5535Издательство «ПедиатрЪ»10.15690/vsp.v23i6.2838vsp-3656Research ArticleОРИГИНАЛЬНАЯ СТАТЬЯORIGINAL ARTICLESСтруктурная морфометрия головного мозга у детей с синдромом дефицита внимания и гиперактивности и коморбидными легкими когнитивными нарушениямиStructural Brain Morphometry in Children with Attention Deficit Hyperactivity Disorder and Comorbid Mild Cognitive Impairmentshttps://orcid.org/0000-0002-8540-3858КаркашадзеГ. А.KarkashadzeGeorge A.

Каркашадзе Георгий Арчилович - кандидат медицинских наук, врач-невролог, заведующий отделом развития мозга в онтогенезе, формирования когнитивных функций и нейробиологии 

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karkga@mail.ruhttps://orcid.org/0000-0002-5282-6504ФирумянцА. И.FirumyantsAlexey I.

Москва

Moscow

ШилкоН. С.ShilkoNikita S.

Москва

Moscow

https://orcid.org/0000-0002-5036-8407СергиенкоН. С.SergienkoNataliya S.

Москва

Moscow

https://orcid.org/0000-0002-0596-631XНестероваЮ. В.NesterovaYulia V.

Москва

Moscow

https://orcid.org/0000-0003-0892-3726ЯцыкЛ. М.YatsykLeonid M.

Москва

Moscow

РуденкоЕ. Н.RudenkoElena N.

Москва

Moscow

ПоллеМ. И.PolleMikhail I.

Москва

Moscow

СалимгарееваТ. А.SalimgareevaTatiana A.

Москва

Moscow

https://orcid.org/0000-0001-9790-7490ГогберашвилиТ. Ю.GogberashviliTinatin Yu.

Москва

Moscow

https://orcid.org/0000-0001-7218-8434СергееваН. С.SergeevaNataliya E.

Москва

Moscow

КонстантинидиТ. А.KonstantinidiTatiana A.

Москва

Moscow

СадиллоеваС. Х.SadilloevaSafarbegim Kh.

Москва

Moscow

https://orcid.org/0009-0006-3747-3743КуракинаМ. А.KurakinaMarina A.

Москва

Moscow

ДьяченкоВ. В.DyachenkoViktor V.

Москва

Moscow

ПоваляеваИ. А.PovalyaevaInessa A.

Москва

Moscow

БогдановЕ. В.BogdanovEvgeniy V.

Москва

Moscow

https://orcid.org/0000-0001-5790-6223РыкуноваА. И.RykunovaAnastasia I.

Москва

Moscow

https://orcid.org/0000-0001-7398-0562ВишневаЕ. А.VishnevaElena A.

Москва

Moscow

https://orcid.org/0000-0002-8936-3590КайтуковаЕ. В.KaytukovaElena V.

Москва

Moscow

https://orcid.org/0000-0003-0317-2425ЭфендиеваК. Е.EfendievaKamilla E.

Москва

Moscow

https://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaLeyla S.

Москва

Moscow

НИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБОУ ВО «РНЦХ им. акад. Б.В. Петровского»РоссияResearch Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of SurgeryRussian FederationНИИ педиатрии и охраны здоровья детей НКЦ №2 ФГБОУ ВО «РНЦХ им. акад. Б.В. Петровского»; РНИМУ им. Н.И. Пирогова (Пироговский Университет)РоссияResearch Institute of Pediatrics and Children’s Health in Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical UniversityRussian Federation202404012025236466482Copyright © Каркашадзе Г.А., Фирумянц А.И., Шилко Н.С., Сергиенко Н.С., Нестерова Ю.В., Яцык Л.М., Руденко Е.Н., Полле М.И., Салимгареева Т.А., Гогберашвили Т.Ю., Сергеева Н.С., Константиниди Т.А., Садиллоева С.Х., Куракина М.А., Дьяченко В.В., Поваляева И.А., Богданов Е.В., Рыкунова А.И., Вишнева Е.А., Кайтукова Е.В., Эфендиева К.Е., Намазова-Баранова Л.С., 20242024Каркашадзе Г.А., Фирумянц А.И., Шилко Н.С., Сергиенко Н.С., Нестерова Ю.В., Яцык Л.М., Руденко Е.Н., Полле М.И., Салимгареева Т.А., Гогберашвили Т.Ю., Сергеева Н.С., Константиниди Т.А., Садиллоева С.Х., Куракина М.А., Дьяченко В.В., Поваляева И.А., Богданов Е.В., Рыкунова А.И., Вишнева Е.А., Кайтукова Е.В., Эфендиева К.Е., Намазова-Баранова Л.С.Karkashadze G.A., Firumyants A.I., Shilko N.S., Sergienko N.S., Nesterova Y.V., Yatsyk L.M., Rudenko E.N., Polle M.I., Salimgareeva T.A., Gogberashvili T.Y., Sergeeva N.E., Konstantinidi T.A., Sadilloeva S.K., Kurakina M.A., Dyachenko V.V., Povalyaeva I.A., Bogdanov E.V., Rykunova A.I., Vishneva E.A., Kaytukova E.V., Efendieva K.E., Namazova-Baranova L.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vsp.spr-journal.ru/jour/article/view/3656

Обоснование. Несмотря на то, что расстройства из группы легких когнитивных нарушений широко распространены при синдроме дефицита внимания и гиперактивности (СДВГ), изучение морфометрических параметров мозга у детей при коморбидных СДВГ легких когнитивных нарушениях еще нигде не проводилось. Цель исследования — определить и провести сравнительный анализ МР-морфометрических параметров мозга у детей с СДВГ в зависимости от наличия или отсутствия сопутствующих расстройств из группы легких когнитивных нарушений. Методы. Участники — дети в возрасте 7–8 лет, объединенные в 4 группы: страдающие СДВГ без коморбидной патологии (КП), СДВГ с легкими когнитивными нарушениями (ЛКН), ЛКН без СДВГ и здоровые дети. Всем участникам проводились магнитно-резонансная томография головного мозга и последующая морфометрия с получением количественных параметров крупных структур головного мозга, извилин коры больших полушарий, подкорковых ядер, мозжечка и боковых желудочков. Результаты. Обследовано 90 детей. В группе СДВГ с ЛКН выявлено достоверное снижение объемов хвостатых ядер с двух сторон и гиппокампа справа, а также снижение объемов коры правых верхнетеменной и супрамаргинальной извилин и полюса лобной доли. В группе СДВГ без КП выявлены другие изменения: снижение объема скорлупы с двух сторон и таламуса слева, увеличение объема шести и снижение объема коры четырех извилин, истончение коры четырех извилин при утолщении коры одной извилины, увеличение объемов четырех долек мозжечка. При ЛКН без СДВГ выявлены двустороннее расширение боковых желудочков, снижение объемов правого бледного шара и коры семи извилин, преимущественно правосторонних, а также снижение объемов четырех долек мозжечка. Прямое сравнение между двумя группами СДВГ показало выраженные различия вплоть до более низкого в группе СДВГ с ЛКН тотального объема коры головного мозга с включением коры пяти левополушарных и семи правополушарных извилин. Участники групп СДВГ, в отличие от нормы и группы ЛКН без СДВГ, не демонстрировали возрастного динамического снижения объемов коры больших полушарий. Заключение. Для СДВГ характерно одновременное наличие двух патогенетических процессов: недоразвития одних отделов коры больших полушарий и задержки возрастных изменений других отделов. Между СДВГ без КП и СДВГ с ЛКН выявлены существенные различия морфометрических параметров, что предполагает дифференцированный подход к лечению таких пациентов и пересмотр подходов к организации морфометрических исследований мозга при СДВГ. Увеличение боковых желудочков при ЛКН может свидетельствовать о вкладе перинатальной патологии в этиологию этих состояний.

Background. Even though mild cognitive impairments are common in patients with attention deficit hyperactivity disorder (ADHD), there are no studies of morphometric brain parameters in children with ADHD and comorbid mild cognitive impairments. Objective. The aim of the study is to determine and perform comparative analysis of MR-morphometric brain parameters in children with ADHD depending on the presence or absence of comorbid mild cognitive impairments. Methods. Participants are children aged from 7 to 8 years with ADHD without comorbid pathology (CP), ADHD with mild cognitive impairment (MCI), MCI without ADHD, and healthy children. All participants underwent brain magnetic resonance imaging followed by morphometry to obtain quantitative parameters of large brain structures, cerebral cortex gyri, basal ganglia, cerebellum, and lateral ventricles. Results. 90 children were examined. ADHD with MCI group has shown significant decrease in the volumes of caudate nuclei bilaterally and hippocampus on the right, as well as decrease in the volumes of right superior parietal gyrus, supramarginal gyrus, and frontal cortex. ADHD without CP group has shown different changes: decrease in the volume of putamen on both sides and thalamus on the left, increase in the volume of six and decrease in the volume of the cortex of four gyri, cortex thinning of four gyri with cortex thickening of one gyrus, volume increase of four cerebellar lobules. MCI without ADHD group has shown bilateral enlargement of lateral ventricles, decrease in the volume of right pallidum and seven gyri cortex, mostly on the right side, as well as decrease in the volume of four cerebellar lobules. Direct comparison between the two ADHD groups has shown significant differences up to lower total cortex volume with 5 gyri of left hemisphere and 7 gyri of right hemisphere in the ADHD with MCI group. Participants of ADHD groups compared to healthy individuals and the MCI without ADHD group did not show any age-related dynamic decrease in the volumes of cerebral cortex. Conclusion. ADHD is characterized by parallel presence of two pathogenetic processes: cerebral cortex hypoplasia and delayed age-related changes in other areas. Significant differences in morphometric parameters were revealed between ADHD without CP and ADHD with MCI. It suggests individual treatment for such patients and revision of approaches to morphometric brain studies in patients with ADHD. Enlargement of lateral ventricles in MCI may indicate the effect of perinatal pathology on these conditions’ etiology.

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The authors declare that there are no conflicts of interest present.