Tourette综合征患儿的预后及影响因素

Prognosis of Children with Tourette Syndrome and Affective Factor

目的探讨影响Tourette综合征(TS)患儿预后的危险因素。方法对1997-2005年在本院就诊的98例TS患儿(男85例,女13例;年龄4～16岁)进行随访。病例均符合《美国精神疾病诊断与统计手册》4版(DSM-Ⅳ)TS诊断标准。采用统一的调查表,由经过专门培训的调查员以直接询问或电话咨询的方式调查。将性别、发病年龄、抽动严重程度、首发症状、精神或神经病家族史、基础病、共患病、围生期异常、家庭关系等临床资料核实整理后,应用SPSS12.0软件进行预后相关危险因素Logistic回归分析。结果随访截止时年龄14～25岁。失访16例,其余82例(男72例,女10例)均得到随访。其中痊愈加好转50例,未愈32例。单因素非条件Logistic回归分析显示有显著意义的变量为发病年龄、抽动严重程度、精神或神经病家族史、基础病、共患病、围生期异常6个因素(Pa<0.05);性别、首发症状、家庭关系3个因素无显著意义(Pa>0.05)。再将选出的6个有意义的危险因素引入多因素Logistic逐步回归分析,共患病、抽动严重程度、家族史3个因素进入最终回归方程(Pa<0.05),其中共患病(OR=84.088,95%CI为10.850～651.682),抽动严重程度(OR=13.956,95%CI为2.412～80.762),家族史(OR=27.127,95%CI为1.047～702.831)影响作用依次由大到小。结论TS患儿的预后与是否合并共患病、是否有精神或神经病家族史以及抽动严重程度等危险因素有关。

Objective To explore the risk factors affecting prognosis of children with Tourette syndrome （TS）. Methods The follow-up visits were conducted on the clinical data of 98 cases with TS （85 male, 13 female;aged 4 - 16 years old） from 1997 to 2005 in Wuhan children＇s hospital. All cases were consistent with the diagnostic criteria of TS in the 4^th edition of Diagnostic and Statistical Manual of Mental Disorders（DSM-Ⅳ）. The investigations were performed by the investigators who received special training using the unified questionnaire with the methods of direct inquiry or by telephone. The factors included sex, age, severity of TS, the primary symptoms, family history, coexisting diseases, basic diseases, perinatal abnormity and family - social relations. The prognosis of TS and these factors were analyzed by linear regression and stepwise regression with SPSS 12.0 software. Results About 16 cases lost follow-up and the other 82 cases with follow-up （72 male and 10 female） received retrospective review. They were 14 to 25 years old with complete data, and 50 cases healed, 32 cases not healed. Results from non-conditional simple variant Logistic regression showed that such cases were associated with the following factors： age, family history of TS, severity of TS, coexisting diseases,basic diseases and perinatal abnormity（Pa〈 0.05 ）. And there was no significance with sex, the primary symptom and family relations （ Pa〉0.05 ）. Out of 6 suspicious factors, there were coexisting diseases （ OR = 84.088,95% CI 10. 850 - 651. 682）, severity of TS （ OR = 13. 956, 95% CI 2. 412 - 80. 762 ）, and family history of TS （ OR = 27. 127, 95% CI 1. 047 - 702. 831 ） of risk factors. Conclusion The long-term prognosis of children with TS may be related with coexisting disease, severity of TS and family history respectively.