难治性Tourette′s综合征90例住院情况分析

Analysis of 90 hospitalized children with refractory Tourette′s syndrome

目的分析难治性Tourette′s综合征(TS)患儿的诊疗过程、治疗方法及临床疗效,为综合性防治难治性TS提供依据。方法对2012年5月至2019年7月在南京医科大学附属脑科医院儿童心理卫生研究中心治疗的90例难治性TS患儿的一般情况、入院前后共患病的诊断、入院期间联合的非药物治疗、入院前后所使用药物种类、入院前及出院时主要抗抽动药物使用剂量及入院后有无共患病的治疗转归情况进行回顾性分析。根据耶鲁抽动症严重程度量表(YGTSS)评分评定患儿的抽动障碍严重程度,以YGTSS评分及减分率评定治疗效果,以临床疗效总评疗效指数(CGI-EI)评分作为最后的疗效评分。结果90例难治性TS患儿中,男82例,女8例;出入院时YGTSS评分比较(25.04±12.77比67.64±12.46),差异有统计学意义(t=27.55,P<0.05);所有患儿出院时有共患病诊断的比例(85.56%)较入院前(47.78%)显著升高,差异有统计学意义(χ^(2)=28.90,P<0.05);入院后联合的非药物治疗种类主要为心理健康教育(90例)、综合行为干预治疗(47例)及放松训练(19例);入院前后所使用药物种类相同,5种入院前及出院时的主要抗抽动药物使用剂量差异均无统计学意义(均P>0.05);入院后有无共患病患儿的治疗转归情况(YGTSS评分和减分率及CGI-EI评分)与入院前比较差异均无统计学意义(均P>0.05)。结论难治性TS患儿的门诊治疗与针对抽动的药物治疗并无疗效差别,而综合性干预的住院治疗可显著改善其临床症状。完善共患病的诊断治疗及联合综合性心理行为干预等非药物治疗是改善难治性TS患儿预后的关键。

Objective To analyze the diagnosis and treatment process,treatment methods and clinical efficacy of children with refractory Tourette′s syndrome(TS),thus providing a basis for comprehensive prevention and treatment of refractory TS.Methods A total of 90 children with refractory TS treated in the Child Mental Health Research Center of Nanjing Brain Hospital Affiliated to Nanjing Medical University from May 2012 to July 2019 were recruited.Their baseline characteristics,diagnosis of comorbidities before and after hospitalization,combined non-drug therapy during hospitalization,the drug types used before and after admission,the dosages of main anti-tic drugs used before admission and at discharge,and the treatment outcomes of comorbidities after admission were retrospectively analyzed.The Yale global tic severity scales(YGTSS)scores and the reduction rate were used to assess the severity of tic disorder and therapeutic effect,and the clinical global impression-efficacy index(CGI-EI)scores were graded for assessing the final therapeutic efficacy.Results Among the 90 children with refractory TS,82 children were males and 8 children were females.There was a significant difference in the YGTSS scores at admission and discharge(25.04±12.77 vs.67.64±12.46)(t=27.55,P<0.05).The proportion of all recruited children diagnosed with comorbidities at discharge was significantly higher than that of admission(85.56%vs.47.78%,χ^(2)=28.90,P<0.05).Combined non-drug therapies after admission mainly included psycho-education and supportive therapy(90 cases),comprehensive behavioral intervention for tics(47 cases)and relaxation therapy(19 cases).The distribution of drugs used before and after admission was the same,and there was no significant difference in the dosages of the five major anti-tic drugs before admission and at discharge(all P>0.05).There were no significant differences in YGTSS scores and reduction rate,and CGI-EI scores of children with or without comorbidities before and after admission(all P>0.05),suggesting the similar therapeutic outcomes.Conclusions There is no difference in efficacy between outpatient treatment and anti-tic medication of children with refractory TS,and a comprehensive hospitalized intervention can significantly improve their clinical symptoms.Diagnosis and treatment of comorbidities and combined non-drug treatments like comprehensive psychological and behavioral interventions are the key events to improve the prognosis of children with refractory TS.