Tourette综合征难治性相关因素的研究

Factors Associated with Refractory Tourette Syndrome

目的图雷特综合征(Tourette syndrome,TS)是一类起病于儿童青少年时期的神经发育障碍。有部分患者经过多种药物系统治疗,症状无改善,本研究探讨导致疾病难治性的相关因素。方法使用美国精神障碍诊断与统计手册第4版(Diagnostic and Statistical Manual of Mental Disorders,Forth Edition,DSM-IV)、综合抽动严重程度量表(Yale Global Tic Severity Scale,YGTSS)对患者进行诊断与评估。随访6个月,根据疗效将患者分为难治性和非难治性患者,进行单因素及多元回归分析寻找导致疾病难治的危险因素。结果单因素分析显示,母孕期不良事件、出生时危险因素、既往重大疾病史、家族史、特殊饮食偏好、依从性、抽动首发部位、各类共患病、年龄、起病年龄、病程、运动抽动及发声抽动次数及频率、发声抽动强度与复杂性、干扰及缺损是TS难治性的相关因素。进一步多元回归分析显示,母孕期不良事件、依从性、起病年龄、病程、发声强度、共患强迫障碍及情绪障碍是TS难治性的相关因素。结论TS难治性的相关因素包括母孕期不良事件(包括严重妊娠反应、吸烟、严重躯体疾病、精神疾病、长期精神刺激、物理损伤、堕胎未成、先兆流产等)、依从性差、起病年龄较早、病程较长、共患强迫障碍、情绪障碍、发声抽动强度评分高。

Objective To compare socio-demographic characteristics and clinical features between refractory Tourette syndrome and non-refractory Tourette syndrome,and to explore relevant clinical factors of refractory Tourette syndrome.Methods According to self-made clinical data questionnaire and The Yale Global Tic Severity Scale(YGTSS),clinical data of patients were collected.They were diagnosed in accordance with Diagnostic and Statistical Manual of Mental Disorders,Forth Edition(DSM-IV).Follow-up was done at least 6 months.According to therapeutic effects,the patients were assigned to refractory Tourette syndrome(enough dose and full course of drug treatment with two different mechanisms:YGTSS,reducing score rate<30%)and non-refractory Tourette syndrome.Results Single factor analysis showed that the factors of P<0.05 were:adverse events during pregnancy,risk factors at birth,previous major disease history,family history,special diet preference,compliance,the first site of convulsion,all kinds of comorbidity,age,age of onset,course of disease,frequency of motor convulsion and vocal convulsion,intensity and complexity of vocal convulsion,interference and defect.Further multiple regression analysis showed that the factors of P<0.05 were:adverse events during pregnancy,compliance,age of onset,course of disease,voice intensity,comorbidities of obsessive compulsive disorder and emotional disorder.Conclusion Possible clinical relevant factors for refractory Tourette syndrome are as follows:adverse events during pregnancy(severe pregnancy reaction,smoking,severe physical illness,mental illness,long-term mental stimulation,physical damage,minor abortion,and threatened abortion),early onset age,long course of disease,comorbidity of obsessive-compulsive disorder and mood disorders,and high vocal intensity scores.