抽动障碍儿童成年预后影响因素的病例对照研究

Analysis of influencing factors on adult prognosis of children with tic disorder:A case-control study

背景抽动障碍(TD)起病于儿童期,部分病例在成年后仍有与抽动相关的损伤。目的了解TD患儿在成年后仍有抽动症状的比例,分析TD患儿成年预后的影响因素。设计病例对照研究。方法对中国中医科学院广安门医院(我院)儿科门诊诊断为TD、现已成年的、病历系统中有患儿家长联系电话的、初诊诊断时行YGTSS评分的患者进行电话随访,根据成年后是否仍有抽动症状分为病例组和对照组,基于自制的随访问卷行随访人群TD影响因素调查。问卷包括病历信息模块:性别、出生日期、联系电话、TD首发年龄、首发症状、初诊YGTSS评分;随访信息模块:儿童期呼吸道炎症病史、家庭教育方式、父母性格、TD家族史、共患病、中药治疗和辅助治疗、18岁以前停止治疗时是否有TD症状,成人期是否有TD相关症状(如有症状即行YGTSS评分)、与儿童期初诊病情对比、当前治疗情况、当前受教育程度。影响因素分析采用单因素分析和二元Logistic回归分析。主要观察指标TD患儿成年后仍有抽动症状的影响因素。结果534例TD患者完成电话随访,病例组262例(49.1%),对照组272例。儿童期治疗均以中药治疗为基础,结合西药等其他治疗。成年期随访时仍在接受治疗31例(11.8%)。病例组成年后病情较儿童期初诊时缓解、相似和加重占比分别为80.2%、6.5%和0.8%;成年后复发33例;YGTSS评分为轻、中和重度占比分别为93.1%、5.7%和1.2%。将单因素Logistic回归分析显示有统计学意义的自变量纳入成年预后影响因素的多因素Logistic回归分析,儿童期停止治疗时有症状(OR=20.35,95%CI:12.30~33.68),有TD家族史(OR=3.54,95%CI:1.40~8.96),父母性格急躁易怒(OR=3.13,95%CI:1.74~5.64),儿童期初诊病情为中重度(OR=2.91,95%CI:1.79~4.75)和反复呼吸道炎症(OR=2.34,95%CI:1.41~3.86)均为TD患儿成年后仍有抽动症状的危险因素。结论儿童TD的成年期预后与TD家族史、儿童期初诊病情严重程度、儿童期停止治疗时是否伴抽动症状、儿童期是否伴反复呼吸道炎症及父母性格密切相关。

Background Tic disorder(TD)is a childhood-onset disease.Some TD patients even suffer from tic-related injuries in adulthood.Objective To investigate the proportion of children with TD who still have tic symptoms in adulthood,and analyze the influencing factors of prognosis of adults with childhood-onset TD.Design Case-control study.Methods Telephone follow-up was conducted for adults who were diagnosed as TD in children in the pediatric outpatient department of Guang'anmen Hospital,China Academy of Chinese Medical Sciences.The patients with home contact numbers recorded in the medical records system and YGTSS rating on initial visit were considered.We divided the patients into a case group and a control group according to whether they still had tic symptoms in adulthood.Based on the self-made follow-up questionnaire,we investigated the influencing factors of TD in the follow-up population.The questionnaire had two parts of medical history and follow-up information.Contents of medical records included gender,date of birth,telephone number,age of first TD,first symptom,YGTSS score at first diagnosis and the follow-up information referred to history of childhood respiratory inflammation,family education style,parents'personality,family history of TD,comorborbity,Chinese medicine treatment and adjuvant therapy,current treatment status,current education level,TD symptoms at the stop of the treatment before the age of 18,and TD-related symptoms in adulthood(if there were symptoms,YGTSS score was performed and compared with the initial diagnosis in childhood).Single-factor analysis and binary logistic regression analysis were used to analyze the influencing factors.Main outcome measures Influencing factors of prognosis of adults with childhood-onset TD.Results Telephone follow-up was completed in 534 TD patients,with 262(49.1%)in the case group and 272 in the control group.Children were treated mainly with traditional Chinese medicine combined with western medicine and other treatments.Thirty-one TD adults(11.8%)were still receiving treatment at the time of follow-up.Compared with childhood,80.2%,6.5%and 0.8%of adult patients had remission,similarity and aggravation,respectively,and 33 cases had relapse in adulthood.The YGTSS scores of TD adults were 93.1%,5.7%,and 1.2%,respectively.Univariate logistic regression analysis showed that statistically significant independent variables entered the multivariate logistic regression analysis of adult prognostic factors.Multivariate logistic regression analysis showed there were five risk factors for the prognosis of adults with childhood-onset TD,including symptoms occurring at the stop of treatment in childhood(OR=20.35,95%CI:12.30-33.68),family history of TD(OR=3.54,95%CI:1.40-8.96),irritable parents(OR=3.13,95%CI:1.74-5.64),moderate to severe disease at initial diagnosis in childhood(OR=2.91,95%CI:1.79-4.75),and recurrent respiratory tract inflammation(OR=2.34,95%CI:1.41-3.86).Conclusion The prognosis of adults with childhood-onset TD is closely related to the family history of TD,the severity of the disease in childhood,the severity at initial diagnosis in childhood,tic symptoms at the stop of treatment in childhood,recurrent respiratory tract inflammation in childhood,and the personality of parents.