urmjУральский медицинский журналUral Medical Journal2949-4389Ural State Medical University10.52420/umj.24.3.78RBQLVFurmj-1833Research ArticleОригинальные статьи | Original articlesOriginal articlesОдномоментное наблюдательное исследование социально-демографических, анте- и интранатальных факторов риска легких когнитивных нарушений и СДВГ у детейSimultaneous Observational Study of Socio-Demographic, Ante- and Intranatal Risk Factors for Mild Cognitive Impairment and ADHD in Childrenhttps://orcid.org/0000-0002-8540-3858КаркашадзеГ. А.KarkashadzeG. A.

Каркашадзе Георгий А.

Москва

Georgiy A. Karkashadze.

Moscow

kark-aga@mail.ruhttps://orcid.org/0000-0002-2209-7531Намазова-БарановаЛ. С.Namazova-BaranovaL. S.

Намазова-Баранова Лейла С.

Москва

Leila S. Namazova-Baranova.

Moscow

https://orcid.org/0000-0002-5250-7351КовтунО. П.KovtunO. P.

Ковтун Ольга П.

Екатеринбург

Olga P. Kovtun.

Ekaterinburg

https://orcid.org/0000-0002-0117-2563РычковаЛ. В.RychkovaL. V.

Рычкова Любовь В.

Иркутск

Lyubov V. Rychkova.

Irkutsk

КирееваГ. Н.KireevaG. N.

Киреева Галина Н.

Москва

Galina N. Kireeva.

Moscow

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

Кайтукова Елена В.

Москва

Elena V. Kaitukova.

Moscow

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

Сергиенко Наталья С.

Москва

Natalia S. Sergienko.

Moscow

ЯцыкЛ. М.YatsykL. M.

Яцык Леонид М.

Москва

Leonid M. Yatsyk.

Moscow

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

Нестерова Юлия В.

Москва

Yulia V. Nesterova.

Moscow

РуденкоЕ. Н.RudenkoE. N.

Руденко Елена Н.

Москва

Elena N. Rudenko.

Moscow

https://orcid.org/0000-0001-7218-8434СергееваН. Е.SergeevaN. E.

Сергеева Наталья Е.

Москва

Natalia E. Sergeeva.

Moscow

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

Гогберашвили Тинатин Ю.

Москва

Tinatin Yu. Gogberashvili.

Moscow

КонстантинидиТ. А.KonstantinidiT. A.

Константиниди Татьяна А.

Москва

Tatiana A. Konstantinidi.

Moscow

КуракинаМ. А.KurakinaM. A.

Куракина Марина А.

Москва

Marina A. Kurakina.

Moscow

СадиллоеваС. Х.SadilloevaS. Kh.

Садиллоева Сафарбегим Х.

Москва

Safarbegim Kh. Sadilloeva.

Moscow

СалимгарееваТ. А.SalimgareevaT. A.

Салимгареева Татьяна А.

Москва

Tatiana A. Salimgareeva.

Moscow

https://orcid.org/0000-0002-1825-5963ПоваляеваИ. А.PovalyaevaI. A.

Поваляева Инесса А.

Москва

Inessa A. Povalyaeva.

Moscow

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

Вишнева Елена А.

Москва

Elena A. Vishneva.

Moscow

ЭфендиеваК. Е.EfendievaK. E.

Эфендиева Камилла Е.

Москва

Kamilla E. Efendieva.

Moscow

https://orcid.org/0000-0002-8682-1840КалюжнаяТ. А.KalyuzhnayaT. A.

Калюжная Татьяна А.

Москва

Tatiana A. Kalyuzhnaya.

Moscow

https://orcid.org/0000-0002-4453-8430ДрапкинаО. М.DrapkinaO. M.

Драпкина Оксана М.

Москва

Oksana M. Drapkina.

Moscow

Научно-исследовательский институт педиатрии и охраны здоровья детей, Научно-клинический центр № 2, Российский научный центр хирургии имени академика Б.В. ПетровскогоРоссияResearch Institute of Pediatrics and Children’s Health, Petrovsky National Research Centre of SurgeryRussian FederationНаучно-исследовательский институт педиатрии и охраны здоровья детей, Научно-клинический центр № 2, Российский научный центр хирургии имени академика Б.В. Петровского; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияResearch Institute of Pediatrics and Children’s Health, Petrovsky National Research Centre of Surgery; Pirogov Russian National Research Medical UniversityRussian FederationУральский государственный медицинский университетРоссияUral State Medical UniversityRussian FederationНаучный центр проблем здоровья семьи и репродукции человекаРоссияScientific Сentre for Family Health and Human Reproduction ProblemsRussian FederationРоссийский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияPirogov Russian National Research Medical UniversityRussian FederationНациональный медицинский исследовательский центр терапии и профилактической медициныРоссияNational Medical Research Center for Therapy and Preventive MedicineRussian Federation20250607202524378–103Copyright © Каркашадзе Г.А., Намазова-Баранова Л.С., Ковтун О.П., Рычкова Л.В., Киреева Г.Н., Кайтукова Е.В., Сергиенко Н.С., Яцык Л.М., Нестерова Ю.В., Руденко Е.Н., Сергеева Н.Е., Гогберашвили Т.Ю., Константиниди Т.А., Куракина М.А., Садиллоева С.Х., Салимгареева Т.А., Поваляева И.А., Вишнева Е.А., Эфендиева К.Е., Калюжная Т.А., Драпкина О.М., 20252025Каркашадзе Г.А., Намазова-Баранова Л.С., Ковтун О.П., Рычкова Л.В., Киреева Г.Н., Кайтукова Е.В., Сергиенко Н.С., Яцык Л.М., Нестерова Ю.В., Руденко Е.Н., Сергеева Н.Е., Гогберашвили Т.Ю., Константиниди Т.А., Куракина М.А., Садиллоева С.Х., Салимгареева Т.А., Поваляева И.А., Вишнева Е.А., Эфендиева К.Е., Калюжная Т.А., Драпкина О.М.Karkashadze G.A., Namazova-Baranova L.S., Kovtun O.P., Rychkova L.V., Kireeva G.N., Kaitukova E.V., Sergienko N.S., Yatsyk L.M., Nesterova Y.V., Rudenko E.N., Sergeeva N.E., Gogberashvili T.Y., Konstantinidi T.A., Kurakina M.A., Sadilloeva S.K., Salimgareeva T.A., Povalyaeva I.A., Vishneva E.A., Efendieva K.E., Kalyuzhnaya T.A., Drapkina O.M.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.umjusmu.ru/jour/article/view/1833Обоснование

Обоснование. Легкие когнитивные нарушения у детей остаются недостаточно изученной проблемой с точки зрения этиопатогенетических аспектов и выявления факторов риска. Во многом это обусловлено пограничным междисциплинарным положением данной области клинических интересов. В ряду других проблем дефицит представлений о происхождении этих состояний обусловливает стагнацию диагностически-терапевтических тактик и стратегий, в частности отсутствуют положения о ранней диагностике этих расстройств.

Цель исследования — определить социально-демографические, анте-, интранатальные и ранние неонатальные предикторы расстройств из группы легких когнитивных нарушений и синдрома дефицита внимания и гиперактивности (СДВГ) у детей.

Методы

Методы. В исследование включались дети 5–12 лет с легкими когнитивными нарушениями (ЛКН), СДВГ, а также неврологически здоровые дети (группа контроля), проживающие в Московской агломерации, Екатеринбурге, Челябинске и Иркутске. Определение критериев включения в группы проводилось на основании данных неврологических осмотров и специализированного нейропсихологического и логопедического тестирования. Родители детей, включенных в исследование, заполняли специально разработанный электронный опросник из 47 пунктов, охватывающих социально-демографические характеристики, условия и обстоятельства течения беременности, родов и раннего неонатального периода. Оценивались различия в частоте распределения изучаемых признаков между группами патологии (ЛКН, СДВГ) и группой контроля (неврологически здоровые дети), определялись отношение шансов иметь ЛКН в зависимости от наличия предиктора и прогностические характеристики модели комбинации нескольких предикторов.

Результаты

Результаты. В исследование включено 344 ребенка, из них 190 детей составило группу контроля, а 154 ребенка основные клинические группы. 120 детей составило группу ЛКН, 72 ребенка группу СДВГ и еще 36 группу коморбидных ЛКН и СДВГ. При ЛКН СДВГ отмечался в 31,7 % случаев. Всего выявлено 18 различных предикторов ЛКН, из которых наиболее значимыми были необходимость в ИВЛ (отношение шансов OR = 22,59; СI: 2,76–185,06), частые/обильные срыгивания (OR = 9,49; СI: 2,04–44,18) и симптоматика неврологического благополучия в целом (OR = 5,60; СI: 2,91–10,76) в ранний неонатальный период. Ведущие предикторы были схожими для ЛКН и СДВГ. Прогностические модели комбинаций наиболее значимых предикторов способны правильно предсказать 92,5 % и 87,5 % исходов между ЛКН и неврологической нормой.

Заключение

Заключение. Не вызывает сомнений, что перинатальные события, воздействующие на мозг, помимо генетических детерминаций должны рассматриваться в качестве фактора риска и этиологического фактора ЛКН и СДВГ. Это ставит вопрос о необходимости выделения групп риска на предмет ранней диагностики патологии и как можно более раннего лечения этих состояний. Вытекающие из результатов исследования предикторы отдельно и в комбинации можно использовать в этих целях. Результаты исследования подталкивают к пересмотру официальных позиций по ведению детей с ЛКН. ЛКН и СДВГ являются близкородственными состояниями, что необходимо учитывать в терапевтических подходах к ведению этих расстройств.

Justification

Justification. Mild cognitive impairment in children remains an insufficiently studied problem in terms of etiopathogenetic aspects and the identification of risk factors. This is largely due to the borderline interdisciplinary position of this area of clinical interest. Among other problems, the lack of understanding of the origin of these conditions leads to the stagnation of diagnostic and therapeutic tactics and strategies, in particular, there are no provisions for the early diagnosis of these disorders.

The aim of the study was to identify socio-demographic, ante-, intranatal, and early neonatal predictors of disorders from the group of mild cognitive impairment and attention deficit hyperactivity disorder in children.

Methods

Methods. The study included children aged 5–12 years with mild cognitive impairment (MCI), attention deficit hyperactivity disorder (ADHD), as well as neurologically healthy children (control group) living in the Moscow agglomeration, Ekaterinburg, Chelyabinsk and Irkutsk. The criteria for inclusion in the groups were determined based on data from neurological examinations and specialized neuropsychological and speech therapy testing. The parents of the children included in the study filled out a specially designed electronic questionnaire of 47 items, covering socio-demographic characteristics, conditions and circumstances of pregnancy, childbirth and the early neonatal period. The differences in the frequency of distribution of the studied signs between the pathology groups (MCI, ADHD) and the control group (neurologically healthy children) were evaluated, the odds ratio of having MCI depending on the presence of a predictor and the prognostic characteristics of the model of a combination of several predictors were determined.

Results

Results. The study included 344 children, of whom 190 children were in the control group, and 154 children were in the main clinical groups. 120 children were in the LCN group, 72 children in the ADHD group, and 36 more in the comorbid MCI and ADHD group. In MCI, ADHD was observed in 31.7 % of cases. A total of 18 different predictors of LVH were identified, of which the most significant were the need for ventilation (odds ratio OR = 22.59; CI: 2.76–185.06), frequent/copious regurgitation (OR = 9.49; CI: 2.04–44.18) and symptoms of neurological well-being in general (OR = 5.60; CI: 2.91–10.76) in the early neonatal period. The leading predictors were similar for MCI and ADHD. Predictive models of combinations of the most significant predictors are able to correctly predict 92.5 % and 87.5 % of outcomes between MCI and the neurological norm.

Conclusion

Conclusion. There is no doubt that perinatal events affecting the brain, in addition to genetic determinations, should be considered as a risk factor and an etiological factor of MCI and ADHD. This raises the question of the need to identify risk groups for early diagnosis of pathology and the earliest possible treatment of these conditions. The predictors resulting from the results of the study can be used separately and in combination for these purposes. The results of the study are pushing for a revision of the official positions on the management of children with MCI. MCI and ADHD are closely related conditions, which must be taken into account in therapeutic approaches to the management of these disorders.

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