北京市大兴区6～16岁中小学生抽动障碍的现况调查

Tic disorders in children aged 6 - 16 years in Daxing district of Beijing ： a cross-sectional study

目的了解大兴区中小学生抽动障碍（TD）的流行病学分布及就医、治疗状况。方法采用分层整群随机抽样法，从大兴区6～16岁中小学生中抽取部分学生进行TD的横断面调查。根据TD国内外研究现况，制定TD初筛问卷，收集学生临床资料，对筛查阳性者及学校教师或同学报告有类似症状者进行面谈及临床评估。采用美国精神障碍诊断与统计手册第4版中TD标准进行诊断和分类。结果TD总患病率为2．26％。其中短暂性抽动障碍（TT）、慢性运动性抽动或发声抽动（CMVT）、发声与多种运动联合抽动障碍（TS）的患病率分别为1．05％、0．73％和0．47％。男生TD患病率3．39％，女生1．04％，差异有统计学意义（x^2=23．883，P〈0．001），患病率比3．27：1（95％可信区间为2．00～5．60）。TD的3种临床亚型的患病率均表现为男生高于女生（TTx^2=12．808，P〈0．001；CMVTx^26．042，P=0．014；TS）（2=4．861，P=0．027）；平均发病年龄（8．0±2．0）岁，发病高峰年龄为5．5～12．0岁；各年龄组患病率以8～9岁组最高。86例TD患者仅16例（19％）因抽动症状就医，就医者中仅5例得到正确诊治。结论TD在大兴区中小学生中较多见，男生患病率高于女生。疾病早期就医率低，正确治疗率低。

Objective To study the epidemiological distribution and treatment of tic disorders （TD） among children in primary and secondary school of Daxing district. Methods Using stratified-cluster random sampling techniques, 4020 children aged 6 - 16 years were selected from 61 836 primary or secondary schoolchildren in Daxing district. The children and their parents were asked to fill in a self- designed questionnaire including both motor and vocal tics and general demographic data. The children who reported with tic symptoms as well as those who were reported by their teachers or classmates were surveyed, and the diagnosis of TD was made according to the Diagnostic and Statistical Manual of Mental Disorders-4th edition criteria. Results The prevalence rate of TD in this sample was 2. 26% , with 3.39% in males and 1.04% in females. The prevalence of transient tic disorders （TT） , chronic motor or vocal tic disorders （CMVT） , Tourette syndrome （TS） were l. 05%, 0. 73% and 0. 47% respectively with the highest rate among 8 - 9 year olds. The mean onset age of TD was （ 8. 0 ± 2. 0） years, with the peak onset age of 5.5 - 12. 0 year olds. Among 86 TD children, only 16 （ 18.6% ） children were accompanied to hospital because of tics, and only 5 were diagnosed and treated correctly by professionals. Conclusion TD is a fairly common disorder among schoolchildren in Daxing district, with high rate of misdiagnosis. Physicians should be trained to identify and treat the syndromes as early as possible.