| 摘要: |
| ［摘要］ 目的 分析情绪失调在注意缺陷多动障碍（ADHD）与抽动障碍（TD）共病患儿胃肠道症状和内化问题的中介作用。方法 招募2024年10月至2025年12月空军军医大学西京医院儿科门诊收治的ADHD、TD患儿90例，其中单纯ADHD患儿30例（ADHD组），单纯TD患儿30例（TD组），ADHD与TD共病患儿30例（ADHD+TD组）。采用SNAP-Ⅳ量表（父母版）、耶鲁综合抽动严重程度量表（YGTSS）、儿童焦虑性情绪障碍筛查表（SCARED）、儿童抑郁障碍自评量表（DSRSC）、罗马Ⅳ儿童胃肠道症状问卷（QPGS-Ⅳ）以及Conners父母症状问卷（PSQ）进行调查评估。结果 ADHD+TD组QPGS-Ⅳ总分、SCARED评分高于ADHD组和TD组，TD组SNAP-Ⅳ量表评分、情绪失调因子评分低于ADHD组和ADHD+TD组，差异有统计学意义（P<0.05）。ADHD+TD组DSRSC评分显著高于TD组（P<0.05），两组YGTSS评分比较差异无统计学意义（P>0.05）。中介效应检验结果显示，胃肠道症状（QPGS-Ⅳ评分）对焦虑（SCARED评分）、抑郁（DSRSC评分）的直接效应显著，情绪失调（PSQ评分）在胃肠道症状与焦虑、抑郁的关联中均发挥部分中介作用，中介效应分别占总效应的26.85%、24.68%。分组分析结果显示，ADHD+TD组情绪失调因子评分在胃肠道症状与焦虑之间的中介效应最为显著［ab=0.142，Bootstrap（95%CI）：0.04～0.27］，而TD组和ADHD组情绪失调因子评分无显著中介效应。结论 ADHD与TD共病患儿胃肠道症状和内化问题存在关联，情绪失调可能是介导二者的重要因素，这为临床综合干预策略的制订提供了参考。 |
| 关键词: 注意缺陷多动障碍 抽动障碍 共病 胃肠道症状 情绪失调 内化行为 中介效应 |
| DOI：10.3969/j.issn.1674-3806.2026.08.07 |
| 分类号:R 749.94 |
| 基金项目:国家自然科学基金面上项目（编号：82571761，82371545）；空军军医大学临床研究项目（编号：2022LC2210） |
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| Gastrointestinal symptoms and internalizing problems in children with comorbid attention-deficit/hyperactivity disorder and tic disorder: the mediating role of emotional dysregulation |
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Sun Haiting1, Qiao Hongyu1, Li Yan2, Jian Fangfang1, Zhao Chenxi1, Wang Xiaolan1, Wang Yanjia1, Xi Jing1, Sun Xin1
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1.Department of Pediatrics, Xijing Hospital, Air Force Medical University, Xi′an 710032, China; 2.Center for Brain Science, the First Affiliated Hospital of Xi′an Jiaotong University, Xi′an 710061, China
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| Abstract: |
| ［Abstract］ Objective To analyze the mediating role of emotional dysregulation in gastrointestinal symptoms and internalizing problems in children with comorbid attention-deficit/hyperactivity disorder(ADHD) and tic disorder(TD). Methods A total of 90 children receiving treatment in the Pediatric Outpatient Clinic of Xijing Hospital of Air Force Medical University from October 2024 to December 2025 were recruited, including 30 children with ADHD(ADHD group), 30 children with TD(TD group), and 30 children with comorbid ADHD and TD(ADHD+TD group). All the participants were surveyed and assessed by using Swanson, Nolan, and Pelham Rating Scale-Ⅳ(SNAP-Ⅳ)-parent form scores, Yale Global Tic Severity Scale(YGTSS) scores, Screen for Child Anxiety Related Emotional Disorders(SCARED) scores, Depression Self-Rating Scale for Children(DSRSC) scores, Questionnaire on Pediatric Gastrointestinal Symptoms, Rome Ⅳ version(QPGS-Ⅳ), and Conners Parent Symptom Questionnaire(PSQ) scores. Results The total QPGS-Ⅳ scores and SCARED scores in the ADHD+TD group were higher than those in the ADHD group and the TD group, and the SNAP-Ⅳ-parent form scores and emotional dysregulation factor scores in the TD group were lower than those in the ADHD group and the ADHD+TD group, with statistically significant differences(P<0.05). The DSRSC scores in the ADHD+TD group were significantly higher than those in the TD group(P<0.05), whereas no significant differences in YGTSS scores were found between the two groups(P>0.05). The results of mediating effect test revealed that gastrointestinal symptoms(QPGS-Ⅳ scores) had significant direct effects on both anxiety(SCARED scores) and depression(DSRSC scores); emotional dysregulation(PSQ scores) partially mediated the associations of gastrointestinal symptoms with anxiety and depression, accounting for 26.85% and 24.68% of the total effects, respectively. The results of subgroup analysis indicated that the mediating effects of emotional dysregulation factor scores between gastrointestinal symptoms and anxiety were most prominent in the ADHD+TD group［ab=0.142, Bootstrap(95%CI): 0.04-0.27］, whereas no significant differences in the mediating effects of emotional dysregulation factor scores were found in the TD group and the ADHD group. Conclusion Gastrointestinal symptoms are associated with internalizing problems in children with comorbid ADHD and TD. Emotional dysregulation may act as an important mediating factor in this association, providing reference for the development of comprehensive clinical intervention strategies. |
| Key words: attention-deficit/hyperactivity disorder(ADHD) tic disorder(TD) comorbidity gastrointestinal symptoms emotional dysregulation internalizing behavior mediating effect |
