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BDNF가 ADHD의 병인과 치료에 미치는 영향

Association between the Brain-Derived Neurotropic Factor and Attention Deficit Hyperactivity Disorder

송재민|곽영숙|강나리
대한생물정신의학회 (The Korean Society Of Biological Psychiatry)|2018.05|생물정신의학 (Journal of Korean Society of Biological Psychiatry)|제25권 제2호|pp. 21-30|DOI 10.22857/kjbp.2018.25.2.001

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주의력결핍 과잉행동장애BDNFAttention deficit hyperactivity disorder (ADHD)Brain-derived neurotropic factor (BDNF)
주제분류정신과학

초록

주의력결핍과잉행동장애(attention deficit hyperactivity disorder, 이하 ADHD)는 소아기에서 가장 흔한 정신과적인장애이며 전 세계적인 유병률은 약 5%로 알려져 있다.1) ADHD는 소아기에 시작하는 신경발달장애로 부주의, 과잉행동과 충동성 등의 주요 증상을 보이며, 사회 적응의 문제, 또래관계의 어려움, 학업 문제, 행동 문제 등 발달 중 여러 가지부정적인 결과를 겪으며, 성인기까지 지속될 경우 도박, 약물남용, 대인관계 문제, 교통사고 등의 심각한 문제들과 연관될 수있어 그 치료의 중요성이 대두되고 있다.2) ADHD의 병인론에 대하여는 많은 부분이 아직 밝혀지지 않은 상태로 최근까지의 연구를 종합해 볼 때, 단일 원인에 의한 것이라기 보다는여러 가지 유전, 신경화학, 환경적 및 심리사회적 위험인자들의 상호작용에 의하여 발생한다는 다요인 이론이 지배적이다. 신경생물학적인 관점에서는 ADHD의 발병에 있어 노르에피네프린(norepinephrine), 도파민(dopamine) 등의 신경전달물질 체계의 장애로 인하여 실행 기능의 이상을 초래하는 것이 ADHD의 발병과 관련이 있을 것이라는 카테콜아민(catecholamine) 가설이 제시되어 왔다.3) 그러나 ADHD의 주요병인론으로 제시된 카테콜아민 가설만으로는 ADHD의 병태생리를 설명하기에는 한계가 있어 새로운 관점이 제시되기 시작하였다.4) ADHD가 신경발달질환(neurodevelopmental disorder) 인 것을 고려할 때, 뉴론의 발달, 생존, 기능 유지에 관여하며 중추신경계의 신경가소성(neuroplasticity)에 관여할 것으로 알려진 신경성장인자들(neurotrophic factors)이 ADHD의 유전적 취약성과 관련이 되어 있는 것으로 제안되고 있다. 그중 brain-derived neurotrophic factor(이하 BDNF)는 중뇌의 도파민 신경세포의 생존 및 분화와5) 청반핵(locus ceruleus) 에서 노르에피네프린의 표현형 분화에 중요한 역할을한다는 점에서,6) ADHD에 영향을 미치는 가장 유력한 neurotrophic growth factor로 주목받고 있으며 일부 연구에서는중뇌에서의 BDNF 활동의 감소가 중뇌의 도파민 기능 이상을 야기시키고 이것이 ADHD의 원인이 된다는 가설이 제안되었다.7) 또한, ADHD 치료에 흔하게 사용되는 중추신경자극제(psychostimulants)와 항우울제(antidepressants)가 BDNF와BDNF 수용체인 tropomyosin-related kinase B(이하 TrkB) 의 발현을 증가시킨다는 보고가 있다.8)9) 이를 바탕으로 여러연구에서 BDNF가 ADHD의 병인론과 치료적 측면에서 중요한역할을 할 것으로 제안되었으며10) 이에 본 연구에서는 ADHD 의 병인과 치료에 있어 BDNF가 미치는 영향을 최근 연구들을 바탕으로 살펴보고자 하였다.

Abstract

Attention deficit hyperactivity disorder (ADHD) is a common childhood psychiatric disorder. Recently, it has been suggested that brain-derived neurotropic factor (BDNF) may play a role in the pathogenesis of ADHD. Our aim of this review is to understand the physiological functions of BDNF and its potential relationship with ADHD and therapeutic approaches of ADHD. Searches were conducted in Pubmed and Research Information Service System (RISS). In this review, we summarized important literatures for the physiological functions of BDNF in neurodevelopment, change of serum BDNF level in ADHD, association of BDNF polymorphism and ADHD and potential association of treatment of ADHD with serum BDNF level. Further studies are required to more clearly understand the source and the role of BDNF in ADHD and to develop BDNF based-ADHD treatement.

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