有周期性发热、口疮性口炎、咽炎和颈部淋巴结炎综合征病史的学龄期儿童注意缺陷/多动障碍症状：与健康同伴的比较评估。

文献信息

中文摘要

目的： 周期性发热、口疮性口炎、咽炎和颈部淋巴结炎（PFAPA）综合征是儿童期最常见的周期性发热综合征，越来越多的证据将生命早期炎症与神经发育联系起来，但PFAPA是否影响学龄期的注意力和行为尚不清楚。本研究比较了学龄前期诊断为PFAPA的学龄期儿童与健康同伴的家长报告注意缺陷/多动障碍（ADHD）症状，并考察其与PFAPA相关临床特征的关联。
材料与方法： 这项横断面研究纳入96名在学龄前期诊断为PFAPA并在儿科风湿病门诊随访的儿童（平均年龄10.84 ± 1.64岁）和81名无慢性疾病或扁桃体切除术的健康对照者（10.40 ± 1.88岁）。注意缺陷/多动障碍症状采用修订版Conners家长评定量表简表（CPRS-R:S）评估。
结果： 两组在年龄或性别方面无差异。在任何CPRS-R:S分量表上均未发现显著的组间差异。在PFAPA组内，症状发作年龄越早与更高的ADHD指数呈弱但显著相关（ρ = -0.317，P = .002），该关联在错误发现率校正后仍显著（错误发现率校正P值[pFDR] = 0.048），并在多变量调整后仍显著（β = -0.295，P = .004）；按合并症、扁桃体切除术和药物使用进行的亚组分析未显示差异。
结论： 学龄前期诊断为PFAPA的儿童在学龄期未表现出家长报告的ADHD症状增加。与更早发病的弱关联需要谨慎解读。这些发现提示，免疫-神经发育关系应以疾病特异性的方式加以考虑，将PFAPA的良性、发作性病程与慢性自身炎症性疾病区分开来。

英文摘要

OBJECTIVE: Periodic fever, aphthous stomatitis, pharyngitis, and cervical adenitis (PFAPA) syndrome is the most common periodic fever syndrome of childhood, and growing evidence links early-life inflammation to neurodevelopment, but whether PFAPA affects attention and behavior at school age is unknown. This study compared parent-reported attention-deficit/hyperactivity disorder (ADHD) symptoms in school-aged children with a preschool PFAPA diagnosis with those of healthy peers and examined associations with PFAPA-related clinical characteristics.
MATERIALS AND METHODS: This cross-sectional study included 96 children (mean age 10.84 ± 1.64 years) diagnosed with PFAPA during the preschool years and followed at a pediatric rheumatology clinic and 81 healthy controls (10.40 ± 1.88 years) without chronic disease or tonsillectomy. Attention-deficit/hyperactivity disorder symptoms were assessed with the Revised Conners' Parent Rating Scale-Short Form (CPRS-R:S).
RESULTS: The groups did not differ in age or sex. No significant between-group difference was found on any CPRS-R:S subscale. Within the PFAPA group, an earlier age at symptom onset was weakly but significantly correlated with a higher ADHD Index (ρ = -0.317, P = .002), and this association remained significant after false discovery rate correction (false discovery rate-adjusted P value [pFDR] = 0.048) and multivariable adjustment (β = -0.295, P = .004); subgroup analyses by comorbidity, tonsillectomy, and medication use showed no differences.
CONCLUSION: Children with a preschool diagnosis of PFAPA did not show increased parentreported ADHD symptoms at school age. The weak association with earlier onset warrants cautious interpretation. These findings suggest that the immune-neurodevelopment relationship should be considered in a disease-specific manner, distinguishing PFAPA's benign, episodic course from chronic autoinflammatory diseases.