中文摘要：

目的：探讨认知行为治疗（CBT）对成人注意缺陷多动障碍（ADHD）患者静息态局部脑功能的影响。方法：被试包括10例18—65岁、符合精神障碍诊断与统计手册第4版（DSM-VI）ADHD诊断标准的患者及12例年龄、性别匹配的正常对照。对成人ADHD患者在CBT治疗前分别使用ADHD评定量表（ADHD—RS）及执行功能行为评定量表成人版自评问卷（BRIEF）进行症状、执行功能的评估，并进行静息态功能磁共振成像（rfMRI）扫描，此后进行12次CBT治疗，治疗完成后进行第2次症状、执行功能评估及MRJ扫描，以观察ADHD症状、执行功能及静息态局部一致性（ReHo）的变化；对正常对照进行一次ADHD症状、执行功能评估及M砌扫描。结果：CBT治疗后ADHD患者的ADHD症状量表总分[（43±7）vs．（31±7），P〈0．01]、注意缺陷分及多动／冲动分降低，BRIEF中的监控[（15±2）vs．（11±2），P〈0．01]及组织因子[（19±5）vs．（14±4），P〈0．01]的分数降低。在脑功能层面，治疗前，成人ADHD患者默认网络内脑区（左侧海马旁回）及双侧前扣带回ReHo值低于正常对照，治疗后，成人ADHD患者默认网络内脑区（右侧海马旁回）及额-顶网络内脑区（右侧中央前、后回及左侧中央后回）的ReHo值增高，但右侧额上回的ReHo值仍低于正常对照（P〈0．05，团块体积〉3051mm^3，校正后P〈0．01）。结论：CBT治疗可以改善成人ADHD患者的核心症状及认知功能，对默认网络内（海马旁回）及额一顶网络内（双侧中央前后回）脑区功能可能有影响，此脑功能的改变可能是ADHD症状和执行功能改善的神经基础。

英文摘要：

Objective： To determine the effects of cognitive-behavioral therapy （CBT） on resting-state brain functional changes in adults with attention-deficit/hyperactivity disorder （ADHD）. Methods： Participants including 10 adults with ADHD aged 18 - 65 years, diagnosed with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition （DSM-IV） and 12 age-and gender-matched healthy controls. The ADHD symptoms and executives functions were assessed using the ADHD Rating Scale （ADHD-RS） and Behavior Rating Inventory of Executive Function （BRIEF） respectively and resting-state functional magnetic resonance imaging were acquired before and after 12-session CBT for ADHD patients. The healthy controls were also scanned. We used the regional homogeneity （ReHo） to capture the changes of regional brain function between pre- and post-CBT in ADHD for measuring the effects of CBT. Results： After CBT, the total scores of ADHD-RS [ （43 ± 7） vs. （31 ± 7）, P 〈 0.01 ], the subscale of inattention and subseale of hyperactivity/impulsivity were decreased in ADHD adults. As for the execu- tive functions, the subscales of monitor [ （ 15 ± 2） vs. （ 11 ± 2）, P 〈 0. 01 ] and organization [ （ 19 _± 5） vs. （ 14 ± 4）, P 〈 0. 01 ] in BRIEF were reduced significantly in adults with ADHD after CBT training. The ReHo was increased in the regions involved in default mode network and fronto-parietal network, i. e., fight parahippocampa gyms, right precentral gyrus, fight postcentral gyms and left postcentral gyms （ Voxels with P 〈 0. 05 and cluster size 〉 3051mm3, which resulted in a corrected threshold of P 〈 0. 01 determined by AlphaSim）. Conelusion： These findings support that CBT could selectively modulate the regional brain function in the default mode network and fron- to-parietal network which may contribute to the improvement of ADHD symptoms and executive functions.