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Article(id=1322926258379698879, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.08.006, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793339798779, onlineDateStr=2026-10-30, pubDate=1754755200000, pubDateStr=2025-08-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793339798779, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793339798779, creator=13701087609, updateTime=1793339798779, updator=13701087609, issue=Issue{id=1322926217711726961, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='8', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1754755200000', pubDateStr='2025-08-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339789083, creator='13701087609', updateTime=1793340517761, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322929274071679978, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322929274071679979, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926217711726961, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=22, endPage=25, ext={EN=ArticleExt(id=1322926258597802688, articleId=1322926258379698879, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Intervention Effect of Ningxin Anshen Decoction（宁心安神汤）on Children with Attention Deficit Hyperactivity Disorder Under Guidance of Brain-Intestinal Axis Theory And Its Effect on Intestinal Flora of The Affected Children, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the effect of Ningxin Anshen Decoction（宁心安神汤）on attention deficit hyperactivity disorder（ADHD）under the guidance of brain-gut axis theory on intestinal flora.

Methods

A total of 102 children with attention deficit hyperactivity disorder were included in the study.They were divided into two groups by random number table method.Fifty-one cases in the control group were treated with Methylphenidate Hydrochloride Tablets，and 51 cases in the observation group were treated with Ningxin Anshen Decoction on this basis.The difference of efficacy，symptom score，Attention Deficit Hyperactivity Disorder Scale（SNAP-Ⅳ），number vanishing test（NCT）error rate，child Behavior Scale（CBCL）and intestinal flora index were compared between the two groups.

Results

The total effective rate of the observation group was 96.08%（49/51），which was much higher than 78.43% （40/51）of the control group（P<0.05）.After treatment，the scores of hyperactivity，restlessness，distraction，polyglot and irritability in the observation group were lower than those in the control group，and the SNAP-Ⅳscore and NCT error rate in the observation group were lower than those in the control group，and the CBCL score was higher than that in the control group（P<0.05）.After treatment，the levels of Bifidobacterium，Lactobacillus and Faecalis in observation group were higher than those in control group，and Enterococcus was lower than those in control group（P<0.05）.

Conclusion

-Ningxin Anshen Decoction under the guidance of brain-gut axis theory have a clear effect in the treatment of attention deficit hyperactivity disorder，which can adjust the balance of intestinal flora，increase the contents of Bifidobacterium and Lactobacillus，effectively improve the symptoms of children，the attention ability and cognitive function，and has high application value.

, authors=Shuai YUAN, Jing LIU, Yuanjun BAO, Zhaohua HUANG, Jia XU, authorsList=Shuai YUAN, Jing LIU, Yuanjun BAO, Zhaohua HUANG, Jia XU, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322926259507966665, articleId=1322926258379698879, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=脑肠轴理论指导下宁心安神汤对注意力缺陷多动障碍干预效果及对患儿肠道菌群的影响分析, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

分析脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍（Attention-deficit hyperactivity disorder，ADHD）患儿对肠道菌群的影响。

方法

纳入102例注意力缺陷多动障碍患儿为研究对象，随机数字表法分为两组，对照组51例采用盐酸哌甲酯片治疗，观察组51例在对照组基础上联合宁心安神汤治疗，对比两组疗效差异、症状评分、注意力缺陷多动障碍量表（Swanson，nolan and pelham-Ⅳrating scales，SNAP-Ⅳ）、数字划消失实验（NCT）失误率、儿童行为量表（Child behavior checklist，CBCL）以及肠道菌群指标变化情况等。

结果

观察组治疗总有效率为96.08%（49/51），远高于对照组的78.43%（40/51）（P<0.05）；治疗后观察组多动不宁、神思涣散、多言多语、性急易怒评分均低于对照组，且治疗后观察组SNAP-Ⅳ评分、NCT失误率低于对照组，CBCL评分高于对照组（P<0.05）；治疗后观察组双歧杆菌、乳酸菌、粪杆菌水平高于对照组，肠球菌低于对照组（P<0.05）。

结论

脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍效果明确，可调节其肠道菌群平衡，增加双歧杆菌和乳杆菌含量，能有效改善患儿症状，提高注意能力及认知功能，具有较高应用价值。

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袁帅（1983-），女，湖北黄梅人，副主任医师，学士，研究方向：儿科。

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组别例数临床控制显效有效无效总有效
观察组5119（37.25）23（45.09）7（13.73）2（3.92）49（96.08）
对照组5115（29.41）13（25.49）12（23.53）11（21.57）40（78.43）
χ28.162 4
P值0.015 2
), ArticleFig(id=1322926263488361201, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=CN, label=表1, caption=

两组注意力缺陷多动障碍患儿治疗效果比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数临床控制显效有效无效总有效
观察组5119（37.25）23（45.09）7（13.73）2（3.92）49（96.08）
对照组5115（29.41）13（25.49）12（23.53）11（21.57）40（78.43）
χ28.162 4
P值0.015 2
), ArticleFig(id=1322926263563858674, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间多动不宁神思涣散多言多语性急易怒
观察组51治疗前5.25±0.24　5.72±1.21　5.46±1.24　5.39±1.02
治疗后2.11±0.14①②1.42±1.24①②2.11±0.42①②1.24±0.14①②
t值19.154 425.454 117.824 319.244 7
P值0.000 00.000 00.000 00.000 0
对照组51治疗前5.24±0.23　5.72±1.27　5.47±1.38　5.37±1.24
治疗后3.78±0.72①3.58±1.47①3.21±0.24①3.14±0.24①
t值14.785 69.845 211.426 313.245 4
P值0.000 00.000 00.000 00.000 0
治疗前t值0.354 80.178 50.325 40.348 5
治疗前P值0.248 60.248 20.248 20.248 7
治疗后t值12.898 714.256 816.785 623.475 2
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322926263643550451, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=CN, label=表2, caption=

两组注意力缺陷多动障碍患儿症状评分比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间多动不宁神思涣散多言多语性急易怒
观察组51治疗前5.25±0.24　5.72±1.21　5.46±1.24　5.39±1.02
治疗后2.11±0.14①②1.42±1.24①②2.11±0.42①②1.24±0.14①②
t值19.154 425.454 117.824 319.244 7
P值0.000 00.000 00.000 00.000 0
对照组51治疗前5.24±0.23　5.72±1.27　5.47±1.38　5.37±1.24
治疗后3.78±0.72①3.58±1.47①3.21±0.24①3.14±0.24①
t值14.785 69.845 211.426 313.245 4
P值0.000 00.000 00.000 00.000 0
治疗前t值0.354 80.178 50.325 40.348 5
治疗前P值0.248 60.248 20.248 20.248 7
治疗后t值12.898 714.256 816.785 623.475 2
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322926263727436532, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SNAP-Ⅳ/（分）NCT失误率/（%）CBCL评分/（分）
观察组51治疗前38.52±5.21　55.62±5.21　49.24±6.52
治疗后12.42±2.42①②31.25±6.52①②76.52±5.24①②
t值12.489 715.795 520.185 4
P值0.000 00.000 00.000 0
对照组51治疗前39.82±5.24　55.47±5.72　49.82±7.02
治疗后24.85±5.14①44.52±7.84①65.14±6.14①
t值8.482 210.456 213.254 4
P值0.000 00.000 00.000 0
治疗前t值0.248 20.148 20.342 1
治疗前P值0.314 30.246 30.214 3
治疗后t值9.152 613.482 515.264 4
治疗后P值0.000 00.000 00.000 0
), ArticleFig(id=1322926263802934005, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=CN, label=表3, caption=

两组注意力缺陷多动障碍患儿SNAP-Ⅳ、NCT失误率、CBCL评分比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数时间SNAP-Ⅳ/（分）NCT失误率/（%）CBCL评分/（分）
观察组51治疗前38.52±5.21　55.62±5.21　49.24±6.52
治疗后12.42±2.42①②31.25±6.52①②76.52±5.24①②
t值12.489 715.795 520.185 4
P值0.000 00.000 00.000 0
对照组51治疗前39.82±5.24　55.47±5.72　49.82±7.02
治疗后24.85±5.14①44.52±7.84①65.14±6.14①
t值8.482 210.456 213.254 4
P值0.000 00.000 00.000 0
治疗前t值0.248 20.148 20.342 1
治疗前P值0.314 30.246 30.214 3
治疗后t值9.152 613.482 515.264 4
治疗后P值0.000 00.000 00.000 0
), ArticleFig(id=1322926263874237174, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数双歧杆菌粪杆菌肠球菌乳酸菌
观察组51治疗前4.35±0.35　3.65±0.21　9.58±1.02　7.24±0.11
治疗后8.62±0.22①②6.58±0.21①②5.12±0.11①②9.58±0.85①②
t值25.487 522.485 226.785 432.785 1
P值0.000 00.000 00.000 00.000 0
对照组51治疗前4.36±0.31　3.64±0.22　9.59±1.01　7.23±0.14
治疗后5.61±0.23①5.11±0.14①7.15±0.13①8.14±0.42①
t值13.489 517.492 619.796 522.789 3
P值0.000 00.000 00.000 00.000 0
治疗前t值0.348 60.282 30.149 90.214 8
治疗前P值0.246 30.172 40.247 30.154 9
治疗后t值15.879 325.479 532.478 521.026 4
治疗后P值0.000 00.000 00.000 00.000 0
), ArticleFig(id=1322926263945540343, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322926258379698879, language=CN, label=表4, caption=

两组注意力缺陷多动障碍患儿粪便中肠道菌群丰度变化情况比较（）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数双歧杆菌粪杆菌肠球菌乳酸菌
观察组51治疗前4.35±0.35　3.65±0.21　9.58±1.02　7.24±0.11
治疗后8.62±0.22①②6.58±0.21①②5.12±0.11①②9.58±0.85①②
t值25.487 522.485 226.785 432.785 1
P值0.000 00.000 00.000 00.000 0
对照组51治疗前4.36±0.31　3.64±0.22　9.59±1.01　7.23±0.14
治疗后5.61±0.23①5.11±0.14①7.15±0.13①8.14±0.42①
t值13.489 517.492 619.796 522.789 3
P值0.000 00.000 00.000 00.000 0
治疗前t值0.348 60.282 30.149 90.214 8
治疗前P值0.246 30.172 40.247 30.154 9
治疗后t值15.879 325.479 532.478 521.026 4
治疗后P值0.000 00.000 00.000 00.000 0
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脑肠轴理论指导下宁心安神汤对注意力缺陷多动障碍干预效果及对患儿肠道菌群的影响分析
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袁帅 , 刘婧 , 鲍远军 , 黄肇华 , 许佳
中华中医药学刊 | 国家项目点击 2025,43(8): 22-25
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中华中医药学刊 |国家项目点击 2025 , 43 (8) : 22 -25
脑肠轴理论指导下宁心安神汤对注意力缺陷多动障碍干预效果及对患儿肠道菌群的影响分析
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袁帅, 刘婧, 鲍远军, 黄肇华, 许佳
作者信息
  • 九江市儿童医院，江西 九江 332000
作者简介:

袁帅（1983-），女，湖北黄梅人，副主任医师，学士，研究方向：儿科。

Intervention Effect of Ningxin Anshen Decoction（宁心安神汤）on Children with Attention Deficit Hyperactivity Disorder Under Guidance of Brain-Intestinal Axis Theory And Its Effect on Intestinal Flora of The Affected Children
Shuai YUAN, Jing LIU, Yuanjun BAO, Zhaohua HUANG, Jia XU
Affiliations
  • Jiujiang Children´s Hospital，Jiujiang332000，Jiangxi，China
出版时间: 2025-08-10 doi: 10.13193/j.issn.1673-7717.2025.08.006
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摘要
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目的

分析脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍（Attention-deficit hyperactivity disorder，ADHD）患儿对肠道菌群的影响。

方法

纳入102例注意力缺陷多动障碍患儿为研究对象，随机数字表法分为两组，对照组51例采用盐酸哌甲酯片治疗，观察组51例在对照组基础上联合宁心安神汤治疗，对比两组疗效差异、症状评分、注意力缺陷多动障碍量表（Swanson，nolan and pelham-Ⅳrating scales，SNAP-Ⅳ）、数字划消失实验（NCT）失误率、儿童行为量表（Child behavior checklist，CBCL）以及肠道菌群指标变化情况等。

结果

观察组治疗总有效率为96.08%（49/51），远高于对照组的78.43%（40/51）（P<0.05）；治疗后观察组多动不宁、神思涣散、多言多语、性急易怒评分均低于对照组，且治疗后观察组SNAP-Ⅳ评分、NCT失误率低于对照组，CBCL评分高于对照组（P<0.05）；治疗后观察组双歧杆菌、乳酸菌、粪杆菌水平高于对照组，肠球菌低于对照组（P<0.05）。

结论

脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍效果明确，可调节其肠道菌群平衡，增加双歧杆菌和乳杆菌含量，能有效改善患儿症状，提高注意能力及认知功能，具有较高应用价值。

脑肠轴理论  /  宁心安神汤  /  注意力缺陷多动障碍  /  肠道菌群  /  盐酸哌甲酯片
Objective

To analyze the effect of Ningxin Anshen Decoction（宁心安神汤）on attention deficit hyperactivity disorder（ADHD）under the guidance of brain-gut axis theory on intestinal flora.

Methods

A total of 102 children with attention deficit hyperactivity disorder were included in the study.They were divided into two groups by random number table method.Fifty-one cases in the control group were treated with Methylphenidate Hydrochloride Tablets，and 51 cases in the observation group were treated with Ningxin Anshen Decoction on this basis.The difference of efficacy，symptom score，Attention Deficit Hyperactivity Disorder Scale（SNAP-Ⅳ），number vanishing test（NCT）error rate，child Behavior Scale（CBCL）and intestinal flora index were compared between the two groups.

Results

The total effective rate of the observation group was 96.08%（49/51），which was much higher than 78.43% （40/51）of the control group（P<0.05）.After treatment，the scores of hyperactivity，restlessness，distraction，polyglot and irritability in the observation group were lower than those in the control group，and the SNAP-Ⅳscore and NCT error rate in the observation group were lower than those in the control group，and the CBCL score was higher than that in the control group（P<0.05）.After treatment，the levels of Bifidobacterium，Lactobacillus and Faecalis in observation group were higher than those in control group，and Enterococcus was lower than those in control group（P<0.05）.

Conclusion

-Ningxin Anshen Decoction under the guidance of brain-gut axis theory have a clear effect in the treatment of attention deficit hyperactivity disorder，which can adjust the balance of intestinal flora，increase the contents of Bifidobacterium and Lactobacillus，effectively improve the symptoms of children，the attention ability and cognitive function，and has high application value.

brain-gut axis theory  /  Ningxin Anshen Decoction（宁心安神汤）  /  attention deficit hyperactivity disorder  /  intestinal flora  /  Methylphenidate Hydrochloride Tablets
袁帅, 刘婧, 鲍远军, 黄肇华, 许佳. 脑肠轴理论指导下宁心安神汤对注意力缺陷多动障碍干预效果及对患儿肠道菌群的影响分析. 中华中医药学刊, 2025 , 43 (8) : 22 -25 . DOI: 10.13193/j.issn.1673-7717.2025.08.006
Shuai YUAN, Jing LIU, Yuanjun BAO, Zhaohua HUANG, Jia XU. Intervention Effect of Ningxin Anshen Decoction（宁心安神汤）on Children with Attention Deficit Hyperactivity Disorder Under Guidance of Brain-Intestinal Axis Theory And Its Effect on Intestinal Flora of The Affected Children[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (8) : 22 -25 . DOI: 10.13193/j.issn.1673-7717.2025.08.006
正文
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注意力缺陷多动障碍（Attention-deficit hyperactivity disorder，ADHD）也被称为多动症，是儿童时期最为常见的一种神经发育性障碍疾病，以注意缺陷、多动/冲动为主要核心症状表现，可伴有学业、社交等方面的功能损害。根据相关数据显示[1-2]，全球范围内注意力缺陷多动障碍儿童的发生率在7.2%，我国儿童的患病率在6.26%。目前关于该病的发生机制仍不是十分清楚，普遍认为是由于遗传、环境等多种因素综合作用下的结果，中医学把注意力缺陷多动障碍归为“躁动”等范畴。近年来研究发现[3-4]肠道菌群作为人体的第二基因组，可通过微生物-肠-脑轴调控中枢神经系统，从而对发育性行为障碍性疾病产生影响。中医认为[5]该病病机在于脏腑失调，五脏均及，神伤为主。宁心安神汤有宁神益智、益气养阴的作用。本次研究在脑肠轴理论指导下用宁心安神汤治疗注意力缺陷多动障碍，获得较好效果。现报道如下。
1　临床资料
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1.1　一般资料
纳入2023年1月—2023年12月我院收治的102例注意力缺陷多动障碍患儿为研究对象，随机数字表法分为两组。纳入标准：①患儿均符合《儿童注意缺陷多动障碍诊疗建议》[6]中关于注意力缺陷多动障碍中的相关诊断标准，均为首次诊断；②韦氏智力测查智商超过80分；③年龄4～12岁；排除标准：①存在严重营养不良或发育障碍者；②严重活动性障碍、智力障碍或精神疾病者；③伴急性胃肠炎、便秘或其他神经系统疾病者；④近期经过系统治疗者；⑤肝肾功能存在严重器质性疾病者。对照组51例，男27例，女24例，年龄4～12岁，平均（6.18±2.14）岁，病程4～26个月，平均（15.62±2.52）月；观察组51例，男29例，女22例，年龄5～12岁，平均（6.19±2.15）岁，病程5～28个月，平均（16.25±2.78）月。两组患者上述资料比较差异无统计学意义（P>0.05），可比性较好。本研究经伦理委员会审批通过，患者均签署同意书以表知情。
1.2　方法
对照组采用盐酸哌甲酯片治疗，给予华润双鹤药业股份有限公司所生产的盐酸哌甲酯片（国药准字H11020678，规格10 mg）口服，每次5 mg，每天2次。
观察组在对照组的基础上，予以宁心安神汤治疗，组方为熟地5 g，枸杞子5 g，五味子3 g，太子参3 g，远志3 g，石菖蒲3 g，茯苓5 g，制作成中药颗粒开水冲服，由我院中药房统一制作分装成颗粒盒装，1盒/次，3次/d。两组持续治疗8周。
两组患儿均辅以行为疗法和心理教育相结合。根据患儿个体化差异①帮助患儿辨别和改变负面思维模式，提高自控和解决问题的能力；②指导患儿家长及老师应用合适的奖励和惩罚方式来改变孩子的行为；③给予患儿及其家庭了解ADHD，让他们认识这只是一种医学状况，而非个人缺陷；④鼓励健康的生活方式，保障充足的睡眠、有益均衡的饮食、合适的体育活动，以及进行心理放松训练。
1.3　观察指标
①疗效评估[7]：经过治疗后患儿多动、注意力不集中等症状基本消失，注意力缺陷多动障碍量表（Swanson，nolan and pelham-Ⅳrating scales，SNAP-Ⅳ）、评分减分率>80%，社会功能及适应能力基本恢复正常，学习成绩明显提高，则为临床控制；经过治疗后患儿注意力不集中、多动等症状明显改善，80%≥SNAP-Ⅳ评分减分率>50%，学习成绩有所提高，则为治疗显效；疗后患儿症状体征较治疗前有好转，50%≥SNAP-Ⅳ评分减分率>30%，学习成绩不稳定，则为治疗有效；治疗后患儿症状改善不明显，SNAP-Ⅳ评分减少≤30%，则为治疗无效。总有效率＝临床控制率+显效率+有效率。②症状评分：以患儿神思涣散、多言多语、多动不宁、性急易怒等四项症状进行评分，依据无、轻、中、重权重评分，分别对应0、2、4、6分，分值越低表示其症状越轻。③SNAP-Ⅳ评分[8]：用SNAP-Ⅳ量表评估患儿行为障碍情况，该量表包括注意力不集中、多动/冲动、对立违抗3个方面内容，包括26项，每项0～3分，最高78分，分值越高表示症状越严重。④数字划消实验（NCT）失误率[9]：在电脑上完成此部分测试，由阿拉伯数字构成，分为5个部分，包括划去数字3，划去3前面的数字，划去3和7之间的数字；划去3和7间的偶数等，通过电脑自动统计失误率。⑤儿童行为量表（Child behavior checklist，CBCL）[10]：采用CBCL评分量表评估患儿治疗前后行为控制情况，包括一般项目、社交能力、行为问题3个方面，总分100分，分值越高表示其控制能力越好。⑥肠道菌群变化情况：于治疗前后采集患儿新鲜粪便0.5 g，加入甘油分散混匀，稀释后采用滴注法接种培养基中，培养48 h，然后对双歧杆菌、肠球菌、乳酸菌、粪杆菌计数，计算每克粪便中含菌数，并取其对数作为肠道菌群丰度，用IgCFU·g-1进行表示。
1.4　统计学方法
应用SPSS 24.0软件完成统计学分析。数据资料均符合正态分布，总有效率用［例（%）］表示，采用χ2检验；症状评分、SNAP-Ⅳ评分、肠道菌群变化等指标用（）表示，用t检验。P<0.05为差异有统计学意义。
2　结果
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2.1　治疗效果比较
观察组治疗总有效率为96.08%，高于对照组的78.43%，组间比较差异有统计学意义（P<0.05）。见表1。
2.2　症状评分比较
治疗前两组多动不宁、神思涣散、多言多语、性急易怒评分比较差异无统计学意义（P>0.05）；治疗后两组多动不宁、神思涣散、多言多语、性急易怒评分均降低（P<0.05），且相较于对照组，观察组评分较低更为明显（P<0.05）。见表2。
2.3　SNAP-Ⅳ、NCT失误率、CBCL评分比较
治疗前两组SNAP-Ⅳ、NCT失误率、CBCL评分比较差异无统计学意义（P>0.05）；治疗后观察组SNAP-Ⅳ评分、NCT失误率低于对照组，CBCL评分高于对照组，组间比较差异有统计学意义（P<0.05）。见表3。
2.4　粪便中肠道菌群丰度变化情况比较
治疗前两组双歧杆菌、肠球菌、乳酸菌、粪杆菌水平比较差异无统计学意义（P>0.05）；治疗后观察组双歧杆菌、乳酸菌、粪杆菌水平高于对照组，肠球菌低于对照组，组间比较差异有统计学意义（P<0.05）。见表4。
3　讨论
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注意力缺陷多动障碍是一种神经发育障碍疾病，是儿童常见疾病之一，若不及时干预当注意力缺陷多动障碍儿童发展至青春期时，其社会适应能力相对较差，且与正常者相比，人格障碍问题、品行问题发生率更高，不仅影响患儿今后生活质量，还增加家庭及社会负担。目前关于该病的发生机制仍不是十分清楚，随着代谢组学检测技术、宏基因组学的发展，肠道菌群被称为第二大脑，认为与机体免疫、代谢、营养等存在十分密切的关系[11-13]。肠-脑轴理念的提出，认为肠道菌群可通过多种途径对神经系统造成影响，促进神经系统疾病的发生、发展[14-15]。
《灵枢·大惑论》指出：“上气不足，下气有余，肠胃实而心肺虚……故善忘也”。其描述与多动症伴学习困难、健忘等症状相符。《小儿药证直诀》指出：“心主惊，肝主风，脾主困……肾主虚……脑名为髓海……又称为元神之府”。指出了小儿五脏的生理、病理特点，并提出五脏和脑存在密切关系[16-20]。尽管中医并没有明确提出脑肠轴的概念，但中医认为五脏藏神功能失调能间接或直接引起脑功能的失衡，使患儿出现性情执拗、急躁易怒、不能静坐、注意力分散等表现[21]，肾元虚元气不足、肝脾涩心神苦散而不收，是ADHD发病的根本病机，故本次研究以宁心安神汤予以治疗。本次研究基于脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍患儿，结果发现治疗后观察组多动不宁、神思涣散、多言多语、性急易怒评分均低于对照组，且治疗后观察组SNAP-Ⅳ评分、NCT失误率低于对照组，CBCL评分高于对照组（P<0.05）。可见该种治疗方式能改善患儿注意力分散、多动等症状表现，提高其认知能力及控制能力。这是由于宁心安神汤是由熟地、枸杞子、五味子、太子参、远志、石菖蒲、茯苓所组成，方中熟地[22]性微温，归于肝肾经，具有填精益髓、滋养养血的作用；太子参[23]微苦，归于脾、肺经，具有生津润肺、健脾益气的作用。二者共为方中君药，两者一阴一阳，一形一气，互主生成，调节阴阳平衡。枸杞子[24]益精明目、补肝益气；五味子[25]益气生津，补肾宁心，二者共为臣药，助力君药奏益气养阴、安神宁心之妙用；远志[26]具有宁心安神、益智的作用；石菖蒲[27]具有开窍醒神、益智宁神的功效；茯苓[28]健脾益气、宁心安神，共为方中佐药。诸药合用共奏宁心安神、补气益智，调节阴阳的功效。肠道菌群[29-30]是一个庞大而复杂的微生物系统，其分布可对大脑的生理代谢产生影响，而对小儿的行为活动产生间接或直接影响。双歧杆菌、肠球菌、乳酸菌、粪杆菌为常见的肠道菌群，张珊等[31]学者通过对注意力缺陷多动障碍患儿肠道菌群特征进行分析发现，患儿肠球杆菌、气味杆菌水平明显增高、粪杆菌水平偏低。较高的肠球杆菌、气味杆菌可通过脑-肠轴促使多巴胺减少，诱发多动症；较低水平的粪杆菌可引起过敏发生，并通过脑-肠轴影响神经递质的释放，使大脑和行为产生异常[32]。双歧杆菌、乳酸菌则能产生γ-氨基丁酸，该物质为人体大脑皮层中一种抑制性神经递质的物质，而注意力缺陷多动障碍患儿γ-氨基丁酸水平明显偏低[33]。本组治疗后观察组双歧杆菌、乳酸菌、粪杆菌水平高于对照组，肠球菌低于对照组（P<0.05）。可见该种治疗方式可调节肠道菌群平衡，减少肠球菌水平，增加双歧杆菌、乳酸菌、粪杆菌含量。分析原因可能是由于宁心安神汤方中枸杞子能调节免疫水平，增强记忆能力；石菖蒲可调节胃肠运动，具有改善学习记忆力的作用；五味子能抑制胃酸过度分泌，调节胃肠功能；诸药合用对肠道菌群进行调节，通过脑肠轴的双向沟通而影响患儿行为及功能，促进其症状的改善。中医和西医在治疗注意力缺陷多动障碍时理论上有很多共同点，尤其在心脾、“肠道微生物-HPA轴”的影响方面比较突出。中医药针对注意力缺陷多动障碍的治疗机制中，不单单是依赖单味药物的作用调节肠道微生物-HPA轴，而是以中医基础理论、儿童病理生理为基础的全面综合调节。通过这种类型的整体调节作用改善肠道菌群构性，从而介导免疫力，进一步影响HPA轴生理功能，从而达到调节患儿体内多巴胺系统功能的作用。
本次研究结果表明，脑肠轴理论指导下宁心安神汤治疗注意力缺陷多动障碍效果明确，可调节其肠道菌群平衡，增加双歧杆菌和乳杆菌含量，能有效改善患儿症状，提高注意能力及认知功能，肯定了中医药在ADHD疾病管理中的独特价值。但现代临床研究仍还存在不足，比如疗效评价标准尚未统一，缺乏多中心和大样本的随机对照试验，对中药的药理作用和机制探究也较为有限。因此，在未来的研究中，我们需要采用更加科学和规范的研究设计与方法，以提供更为可靠的临床数据，从而推动中医药在ADHD治疗领域的进一步发展。
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  • 国家自然科学基金项目(81560723)
  • 江西省卫生健康委科技计划项目(SKJP220227792)
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2025年第43卷第8期
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doi: 10.13193/j.issn.1673-7717.2025.08.006
  • 首发时间：2026-10-30
  • 出版时间：2025-08-10
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国家自然科学基金项目(81560723)
江西省卫生健康委科技计划项目(SKJP220227792)
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    九江市儿童医院，江西 九江 332000
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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