链球菌感染相关的自身免疫反应与儿童抽动障碍的临床血清学研究

Clinico-Serlogical Observation on the Tic Disorder and Pediatric Autoimmune Neuropsychiatric Disorder With Streptococcal Infections

目的从临床血清学研究角度探讨链球菌感染(streptococcal infections)相关的自身免疫反应与抽动障碍(tic disorder,TD)发病的关系。方法采用乳胶凝集法、微量法及间接免疫荧光法测定2007年3月至6月在成都市儿童医院神经精神专科门诊及住院确诊为抽动障碍患儿80例(TD组,n=80)和同期在该院儿童保健科体检的健康儿童40例(对照组,n=40)的抗链球菌抗体(anti-streptococcal antibody)中抗链球菌溶血素"O"(anti-streptolysin"O",ASO),抗DNA酶B(anti-deoxyribonuclease B,ADNB)及抗基底神经节抗体(anti-basal ganglia antibodies,ABGA),并比较TD组和对照组抗GAS抗体和ABGA的差异。TD组患儿中,将病情呈发作性和抽动出现或加重前有发热、咽痛等上呼吸道感染史患儿纳入TD1组(n=48),其余纳入TD2组(n=32),并比较TD1组和TD2组上述指标的差异(本研究遵循的程序符合成都市儿童医院人体试验委员会所制定的伦理学标准,得到该委员会批准,并与试验患儿监护人签署临床研究知情同意书)。结果TD组抗A族β溶血性链球菌(group Aβ-streptococal,GAS)抗体、抗基底神经节抗体阳性率较对照组高,两组比较,差异有显著意义(χ2=9.216,P<0.05;χ2=7.702,P<0.05);TD1组与TD2组抗A族β溶血性链球菌抗体和抗基底神经节抗体比较,差异有显著意义(χ2=7.068,P<0.05;χ2=13.203,P<0.05),且TD1组中9例患儿基本符合链球菌感染相关的儿童自身免疫性神经精神障碍(pediatric autoi mmune neuropsychiatric disorder with streptococcal infections,PANDAS)的诊断标准。结论在遗传易感性基础上,链球菌感染后的自身免疫反应可能为诱发抽动障碍的一种环境因素;链球菌感染相关的儿童神经紊乱自身免疫反应可能为抽动障碍的一种临床亚型。

Objective To explore the relationship between pediatric autoimmune neuropsychiatric disorder with streptococcal infections （PANDAS）and tic disorder（TD）from clinical serum research angle. Methods The titers of anti-streptococcal antibody（ASO, ADNB）and anti-basal ganglia antibodies（ABGA） were assaied by adoptlatex agglutination, micromethod and indirect immunofluorescence （IFL）in 80 tic disorder patients （who were diagnosed in the Department of Nerve-Spiritual, Chengdu Children＇s Hospital from March to June,2007）, and 40 health children were involved in the control group in the same period. TD group were subdivided into TD1 group （n=48） and TD2 group （n=32）. TD1 group had episodic course and/or the history of upper respiratory infection with fever and sore throat prior to symptomatic attacks. Informed consent was obtained from all participants. Results The positive rate of serum anti-streptococcal antibody and anti-basal ganglia antibody in TD group were significantly higher than those in the control group（X^2 = 9.216, P〈0.05 ; X^2 = 11. 326, P〈0.05）. 51.4 % of tie disorder children with positive anti-basal ganglia antibody had at least one positive anti-streptococcal antibody, which significantly higher than that in tic disorder children with negative anti-basal ganglia antibody （ X^2= 8. 09, P〈0. 05）. Meanwhile, the positive rate of serum anti-streptococcal antibody and anti-basal ganglia antibody in TD1 group were significantly higher than those in TD2 group（X^2=7. 068,P〈0.05;X^2=20. 122,P〈0.05）. There were 9 patients in TD1 group consistent with the diagnostic criteria of pediatric autoimmune neuropsychiatric disorder with streptococcal infections. Conclusion ① On the base of genetic predisposition, post-streptococcal autoimmune may he an environmental factor that can induce tic disorder.②Pediatric autoimmune neuropsychiatric disorder with streptococcal infections may be one of the clinical groups of tic disorder.