切换至 "中华医学电子期刊资源库"

中华诊断学电子杂志 ›› 2013, Vol. 01 ›› Issue (01) : 25 -31. doi: 10.3877/cma.j.issn.2095-655X.2013.01.005

所属专题: 专题评论 文献

临床研究

儿童抽动障碍的诊断与评估:单中心10年回顾性研究
衣明纪1,(), 马遥2, 刘秀梅3, 冉霓1, 冯雪英1, 杨召川1, 王艳霞1, 魏书珍1   
  1. 1. 266003 青岛大学医学院附属医院儿童保健科
    2. 青岛市妇女儿童医院
    3. 附属烟台毓璜顶医院
  • 收稿日期:2013-10-19 出版日期:2013-11-26
  • 通信作者: 衣明纪
  • 基金资助:
    国家自然科学基金(81101017)

Diagnosis and assessment of tic disorders in children : A 10-year clinical studies in single center

Mingji Yi1,(), Yao Ma2, Xiumei Liu3, Ni Ran1, Xueying Feng1, Zhaochuan Yang1, Yanxia Wang1, Shuzhen Wei1   

  1. 1. Department of Child Health Care, Affiliated Hospital of Medical College, Qingdao University, Qingdao 266003, China
  • Received:2013-10-19 Published:2013-11-26
  • Corresponding author: Mingji Yi
  • About author:
    Corresponding author: Yi Mingji, Email:
引用本文:

衣明纪, 马遥, 刘秀梅, 冉霓, 冯雪英, 杨召川, 王艳霞, 魏书珍. 儿童抽动障碍的诊断与评估:单中心10年回顾性研究[J/OL]. 中华诊断学电子杂志, 2013, 01(01): 25-31.

Mingji Yi, Yao Ma, Xiumei Liu, Ni Ran, Xueying Feng, Zhaochuan Yang, Yanxia Wang, Shuzhen Wei. Diagnosis and assessment of tic disorders in children : A 10-year clinical studies in single center[J/OL]. Chinese Journal of Diagnostics(Electronic Edition), 2013, 01(01): 25-31.

目的

探讨儿童抽动障碍(tic disorders,TD)的诊断与评估现状,为综合防治儿童抽动障碍提供理论依据。

方法

对1999年1月至2008年12月在青岛大学医学院附属医院儿童保健科就诊的2002例抽动障碍患者的性别、发病年龄、诊断与评估等进行回顾性分析。

结果

(1)10年间TD病例资料完整者2002例,其中男性1608名,女性394名,男∶女为4.08∶1,发病年龄10个月至21岁,3~9岁为发病高峰;(2)TTD组471例,19.11%(90/471)合并共病,ADHD、OCD、焦虑症分别占14.65%(69/471)、5.31%(25/471)、3.18%(15/471);67.52%(318/471)首发症状为简单运动性抽动,57.96%(273/471)表现为眼部症状。CTD组689例,63.86%(440/689)合并共病,ADHD、OCD、焦虑症分别占51.38%(354/689)、20.32%(140/689)、11.76%(81/689);66.91%(461/689)首发症状为简单运动性抽动,68.21%(470/689)表现为眼部症状。TS组842例,74.23%(625/842)合并共病,ADHD、OCD、焦虑症分别占57.96%(488/842)、25.06%(211/842)、23.75%(200/842);81.47%(686/842)首发症状为简单发声性抽动,88.95%(749/842)表现为清嗓;(3)儿童抽动障碍既往诊疗过程中,3种类型的误诊率分别为58.82%(70/119), 55.07%(125/227), 34.76%(162/466)。3组各有226例(47.98%,226/471)、211例(30.62%,211/689)、200例(23.75%,200/842)患者未曾复诊。(4)初诊确定诊断者98.20%(1966/2002)。既往诊疗过程中定量评估抽动严重程度者0.99%(8/812),评估共病ADHD者37.68%(306/812),未见进行OCD评估者;在本院诊疗中评估抽动严重程度者10.54%(211/2002),评估共病ADHD者61.19%(1225/2002),评估OCD者33.57%(672/2002)。

结论

TD可以2岁以内发病,高峰发病年龄3~9岁,较文献报道提前;男性患病率明显高于女性。抽动症状形式多样,最常见于眼部症状、清嗓,易造成误诊;普遍存在共病现象,ADHD、OCD、焦虑症为最常见的3种。诊断过于草率,复诊不规范,症状严重程度定量和共病评估少。

Background

Tic disorders (TD) is a childhood onset neuropsychiatric disorder characterized by single or multiple motor tics or vocal/phonic tics.To date, the etiology and pathogenesis of TD is not definite.Tic symptoms and comorbidities seriously harm physical and mental health in children.Objective To summarize the clinical characteristics, diagnosis and assessment of tic disorders in children so as to provide theoretical evidence for comprehensive prevention and treatment of TD.

Methods

A total of 2002 TD cases were enrolled from 1999 to 2008 in the Children Health Care Department of the Affiliated Hospital of Medical College, Qingdao University.All cases were analyzed retrospectively.

Results

(1) There were 2002 cases children with TD in total. Male VS. female was 4.08∶1(1608∶394). The onset age were from 10 months to 21 years old. The peak onset age of TD ranged from 3 to 9 years old. (2) There were 471 cases of transient tic disorders(TTD). 90 patients had comorbidities. Attention deficit hyperactivity disorder(ADHD), obsessive-compulsive disorder(OCD), anxiety disorders accounted for 14.65%, 5.31%, 3.18%, respectively. 67.52%(318/471) of patients had simple motor tics as the initial symptom, and 57.96%(273/471) patients presented eye blinking. There were 689 cases of chronic tic disorders (CTD). 440 patients had comorbidities. ADHD, OCD, anxiety disorders accounted for 51.38%, 20.32%, 11.76%, respectively. 66.91%(461/689) of patients had simple motor tics as the initial symptom, 68.21%(470/689)presented eye blinking. There were 842 cases of Tourette syndrome (TS). 625 patients had comorbidities. ADHD, OCD, anxiety disorders were accounted for 57.96%, 25.06%, 23.75%, respectively. 81.47%(686/842) of patients had simple phonic tics as the initial symptom, 88.95%(749/842)presented throat clearing. (3) The misdiagnosed rate of three types were 58.82%(70/119), 55.07%(125/227), 34.76%(162/466) separately during previous diagnosis and treatment. 226(48.0%, 226/471), 211(30.6%, 211/689), 200(23.8%, 200/842)children had never further consultation with a doctor. (4) 98.20%(1966/2002)children were diagnosed as TD preliminarily. The symptoms severity degree of 0.99%(8/812)children were assessed during previous diagnosis and treatment, 37.68%(306/812) children were assessed with ADHD, No children were assessed with OCD; The symptoms severity degree of 10.54%(211/2002) children were assessed, 61.19%(1225/2002) children were assessed with ADHD, 33.57%(672/2002) children were assessed with OCD when they came to our hospital.

Conclusions

The onset age and the peak onset age of TD emerged more earlier than before. The prevalence in male was significantly higher than that in female. The cardinal symptoms were eye blinking and throat clearing. The misdiagnosed rate of TD was high. It was common in patients with comorbidities, ADHD, OCD, anxiety disorders were the main three types.Assessment of symptoms severity degree and comorbidity were often absent. These results showed that there were lots of problems in diagnosis and assessment of TD.

图1 1999年1月至2008年12月患者性别分布
图2 研究对象发病年龄分布
表1 各组间性别分布情况比较(例)
图3 TTD组既往初次诊断分布图
图4 CTD组既往初次诊断分布图
图5 TS组既往初次诊断分布图
图6 抽动障碍各亚型共患病情况
表2 抽动障碍各亚型首发症状类型比较(例数,%)
表3 抽动障碍各亚型症状复杂程度比较(例数,%)
表4 抽动障碍各亚型首发症状部位比较(例数)
表5 TD患者各组首次复诊时间比较(例数)
[1]
Hong SB,Kim JW,Shin MS, et al. Impact of family environment on the development of tic disorders: epidemiologic evidence for an association[J]. Ann Clin Psychiatry, 2013, 25(1): 50-58.
[2]
Steinberg T,Tamir I,Zimmerman-Brenner S, et al. Prevalence and comorbidity of tic disorder in Israeli adolescents: results from a national mental health survey[J]. Isr Med Assoc J, 2013, 15(2): 94-98.
[3]
Roessner V,Rothenberger A,Rickards H, et al.European clinical guidelines for Tourette syndrome and other tic disorders[J]. Eur Child Adolesc Psychiatry, 2011, 20(4): 153-154.
[4]
Roessner V,Plessen KJ,Rothenberger A, et al. European clinical guidelines for Tourett syndrome and other tic disorders. Part II: pharmacological treatment[J]. Eur Child Adolesc Psychiatry, 2011, 20(4): 173-196.
[5]
Robertson MM.The prevalence and epidemiology of Gilles de la Tourette syndrome. Part 2: tentative explanations for differing prevalence figures in GTS, including the possible effects of psychopathology, aetiology, cultural differences, and differing phenotypes[J]. J Psychosom Res, 2008, 65(5): 473-486.
[6]
Subspecialty Group of Neurology, The Society of Pediatrics, Chinese Medical Association. Diagnosis and treatment recommendations for tic disorders in children[J]. Zhonghua Er Ke Za Zhi, 2013, 51(1): 72-75.
[7]
吴舒华,刘智胜,孙丹, 等. Tourette综合征患儿的预后及影响因素[J]. 实用儿科临床杂志, 2008, 23(12): 934-935.
[8]
Cath DC,Hedderly T,Ludolph AG, et al.European clinical guidelines for Tourette syndrome and other tic disorders.Part I: assessment[J]. Eur Child Adolesc Psychiatry, 2011, 20(4): 155-171.
[9]
Ludolph AG,Roessner V,Münchau A, et al. Tourette syndrome and other tic disorders in childhood, adolescence and adulthood[J]. Dtsch Arztebl Int, 2012, 109(48): 821-828.
[10]
Cavanna AE,Luoni C,Selvini C, et al. Disease-specific quality of life in young patients with tourette syndrome[J]. Pediatr Neurol, 2013, 48(2): 111-114.
[11]
McNaught KS,Mink JW.Advances in understanding and treatment of Tourette syndrome[J]. Nat Rev Neurol, 2011, 7(12): 667-676.
[12]
Abi-Jaoude E,Gorman DA.Tourette syndrome[J]. CMAJ, 2013, 185(3): 236.
[13]
Grabli D,McCairn K,Hirsch EC, et al. Behavioural disorders induced by external globus pallidus dysfunction in primates:I. Behavioural study[J]. Brain, 2004, 127(9): 2039-2054.
[14]
Wang Z,Maia TV,Marsh R, et al.The neural circuits that generate tics in Tourette's syndrome[J]. Am J Psychiatry, 2011, 168(12): 1326-1337.
[15]
Cohen SC,Leckman JF,Bloch MH.Clinical assessment of Tourette syndrome and tic disorders[J]. Neurosci Biobehav Rev, 2013, 37(6): 997-1007.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 唐金侨, 叶宇佳, 王港, 赵彬, 马艳宁. 医学影像学检查方法在颞下颌关节紊乱病中临床应用研究进展[J/OL]. 中华口腔医学研究杂志(电子版), 2024, 18(06): 406-411.
[3] 赵林娟, 吕婕, 王文胜, 马德茂, 侯涛. 超声引导下染色剂标记切缘的梭柱型和圆柱型保乳区段切除术的效果研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 634-637.
[4] 屈翔宇, 张懿刚, 李浩令, 邱天, 谈燚. USP24及其共表达肿瘤代谢基因在肝细胞癌中的诊断和预后预测作用[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 659-662.
[5] 熊鹰, 林敬莱, 白奇, 郭剑明, 王烁. 肾癌自动化病理诊断:AI离临床还有多远?[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(06): 535-540.
[6] 梁丽斯, 李洁, 贺帅, 来艳君, 刘铭, 张琳. MMP-9、MMP-2 及TLR4、HE4对非小细胞肺癌早期诊断意义[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 756-761.
[7] 王秋生. 胆道良性疾病诊疗策略[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 779-782.
[8] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[9] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[10] 袁雨涵, 杨盛力. 体液和组织蛋白质组学分析在肝癌早期分子诊断中的研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 883-888.
[11] 李浩, 陈棋帅, 费发珠, 张宁伟, 李元东, 王硕晨, 任宾. 慢性肝病肝纤维化无创诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(09): 863-867.
[12] 谭瑞义. 小细胞骨肉瘤诊断及治疗研究现状与进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(08): 781-784.
[13] 王子阳, 王宏宾, 刘晓旌. 血清标志物对甲胎蛋白阴性肝细胞癌诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 677-681.
[14] 陈慧, 邹祖鹏, 周田田, 张艺丹, 张海萍. 皮肤镜对头皮红斑性皮肤病辅助鉴别诊断的研究进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 692-698.
[15] 胡云鹤, 周玉焯, 付瑞瑛, 于凡, 李爱东. CHS-DRG付费制度下GB1分组住院费用影响因素分析与管理策略探讨[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 568-574.
阅读次数
全文


摘要