中药联合重复经颅磁刺激治疗Tourette综合征的临床疗效观察

Clinical efficacy of traditional Chinese medicine combined with repetitive transcranial magnetic stimulation in the treatment of Tourette syndrome

目的观察中药联合重复经颅磁刺激治疗Tourette综合征的临床疗效。方法选取2021年1月至2023年7月在成都市中西医结合医院儿童康复中心就诊的Tourette综合征患儿58例,随机分为西药组20例、中药组17例和联合治疗组21例。西药组给予阿立哌唑片;中药组给予静心止动方制成免煎颗粒剂;联合治疗组在中药组治疗基础上加低频重复经颅磁刺激治疗。治疗疗程均12周。疗程结束后观察各组疗效、耶鲁综合抽动严重程度量表(YGTSS)评分、Conners父母问卷6项因子评分及安全性评价。结果3组临床总有效率比较差异无统计学意义(P>0.05)。YGTSS评分的组别*时间交互效应有统计学意义(P<0.05),3组YGTSS评分均随治疗时间递减,与本组治疗前比较,3组治疗均能有效改善YGTSS评分(P=0.000),治疗后3组YGTSS评分差异无统计学意义(P>0.05)。Conners父母问卷在品行问题、身心障碍、冲动多动和多动指数4个因子评分的组别*时间交互效应有统计学意义(P<0.05)。3组Conners父母问卷各因子评分均随治疗时间递减,与本组治疗前比较,3组治疗均能有效改善Conners父母问卷各因子评分,差异有统计学意义(P<0.05)。联合治疗组在品行问题、身心障碍、冲动多动及多动指数4个因子的改善优于西药组,差异有统计学意义(P<0.05),在冲动多动和多动指数2个因子的改善优于中药组,差异有统计学意义(P<0.05)。3组治疗在学习问题和焦虑2个因子比较差异无统计学意义(P>0.05)。结论中药联合低频重复经颅磁治疗Tourette综合征不仅能更快缓解抽动症状,同时可更有效改善患儿身心障碍及品行问题等相关心理、情绪障碍,特别在改善多动、冲动相关问题行为方面具有更显著的疗效,值得临床推广应用。

Objective To observe the clinical effect of traditional Chinese medicine combined with repetitive transcranial magnetic stimulation in the treatment of Tourette syndrome.Methods A total of 58 patients treated in our hospital from January 2021 to July 2023 were randomly divided into western medicine group(n=20),traditional Chinese medicine group(n=17)and combined treatment group(n=21).The patients in the three groups were treated with traditional Chinese medicine,traditional Chinese medicine combined with low frequency repetitive transcranial magnetic therapy,and aripiprazole,respectively.Results There was no statistically significant difference in the total clinical effective rate among the three groups(P>0.05).The group*time interaction effect of YGTSS score was statistically significant(P<0.05).YGTSS scores in all three groups decreased with treatment time.Compared with before treatment in each group,the treatment for all three groups was able to effectively improve YGTSS scores(P=0.000).After treatment,there was no significant difference in YGTSS scores among the three groups(P>0.05).The Conners Parental Questionnaire showed statistically significant group*time interaction effects(P<0.05)in the scores of four factors:conduct problems,physical and mental disorders,impulsivity-hyperactivity,and hyperactivity index.The scores of each factor in the Conners parental questionnaire in three groups decreased with treatment time.Compared with before treatment in each group,the treatment for all three groups was able to effectively improve the scores of each factor in the Conners parental questionnaire,and the difference was statistically significant(P<0.05).The combined treatment group showed better improvement than the western medicine group in four factors:conduct problems,physical and mental disorders,impulsivity-hyperactivity,and hyperactivity index,with statistical significance(P<0.05);the improvement in impulsivity-hyperactivity and hyperactivity index was better than that in the Chinese medicine group,with statistical significance(P<0.05).There was no statistically significant difference in the two factors of learning problems and anxiety among the three treatment groups(P>0.05).Conclusion Traditional Chinese medicine combined with low-frequency repetitive transcranial magnetic therapy for Tourette syndrome can not only relieve tic symptoms faster,but also improve children's psychological and emotional disorders such as physical and mental disorders and conduct problems,especially in the improvement of hyperactivity and impulsivity-related behavior problems,which is worthy of clinical application.