258例抽动障碍与慢性鼻炎共存的发病机制探讨

Study on Pathogenesis of Tic Disorders Accompanied by Chronic Rhinitis Among 258 Cases

目的:探讨慢性鼻炎诱发抽动障碍的发病机制。方法:参照耶鲁整体抽动严重程度量表(YGTSS)及自编抽动障碍(TD)初筛问卷,根据《美国精神障碍诊断与统计手册》第4版(DSM-Ⅳ)TD诊断标准以及《诸福棠实用儿科学》第7版慢性鼻炎诊断标准,对400例抽动障碍患儿进行临床筛查,筛选出258例抽动障碍伴有慢性鼻炎患儿。检测其T淋巴细胞亚群、免疫球蛋白、IL-6、TNF-α等相关免疫学指标,进行发病机制分析。结果:伴鼻炎TD患儿鼻动症状积分高于不伴鼻炎患儿症状积分,抬臂症状积分、手动症状积分均低于不伴鼻炎患儿,且伴鼻炎TD患儿耶鲁评分高于不伴鼻炎患儿耶鲁评分;与不伴鼻炎TD患儿相比,伴鼻炎TD患儿体内T细胞水平明显降低(P<0.05);与不伴鼻炎TD患儿相比,伴鼻炎TD患儿体内免疫球蛋白水平略低,伴鼻炎TD患儿体内IL-6水平有升高趋势,而TNF-α水平有降低趋势。结论:慢性鼻炎是诱发抽动障碍发病机制因素之一。

This study was aimed to explore the tic disorders （ TD ） pathogenesis induced by chronic rhinitis . A total of 400 TD children were all investigated with self-made TD general questionnaire , Yale Global Tic Severity Scale （ YGTSS ） , TD diagnostic criteria by DSM-IV , chronic rhinitis diagnostic criteria by Zhu-Fu-Tang Textbook of Pediatrics （ 7th edition ） . A total of 258 TD children accompanied with chronic rhinitis were screened . Levels of peripheral blood T lymphocyte subsets , immunoglobulins , IL-6 , TNF-α and other related immunological indexes were detected to analyze pathogenesis. The results showed that the nose movement symptom scores of TD children with rhinitis were higher than the score of TD children without rhinitis . The score of arm-lifting and hand movement in TD children with rhinitis was lower than the score in the TD children without rhinitis . And the YGTSS score of TD children with rhinitis was higher than TD children without rhinitis. Compared with TD children without rhinitis, the level of peripheral blood T lymphocyte subsets in TD children with rhinitis was obviously reduced （ P 〈 0 . 05 ） . Compared with TD children without rhinitis , the level of immunoglobulins in TD children with rhinitis was slightly reduced . The level of IL-6 in TD children with rhinitis tended to increase , but the level of TNF-α tended to reduce . It was concluded that chronic rhinitis is one of the factors to induce TD .