目的 分析共患和不共患注意力缺陷多动障碍(ADHD)的抽动障碍(TD)患儿临床特征,为临床治疗提供思路。方法 病例随机选自2018年6月-2019年11月就诊于中国中医科学院广安门医院儿科6～12岁符合研究标准的单纯TD患儿及TD共患ADHD(TD+ADHD)患儿共计408例(单纯TD患儿296例,TD+ADHD患儿112例),调查两组患儿抽动障碍病程、亚型分布、抽动障碍始发年龄等发病情况以及疾病严重程度方面的差异;分析TD+ADHD组患儿注意缺陷多动障碍病情分布情况。结果 在耶鲁综合抽动严重程度量表(YGTSS)总分及损害率方面,TD+ADHD组明显高于单纯TD患儿(t=-23.24、-19.17,P＜0.001),但其分值高低却不受ADHD亚型的影响;在TD+ADHD患儿组中,注意缺陷子量表分值高于多动/冲动子量表(t=2.96,P＜0.05);与TD共患注意缺陷为主型ADHD(TD+ADHD-I)患儿相比,TD共患多动/冲动为主型ADHD(TD+ADHD-HI)与TD共患混合型ADHD(TD+ADHD-C)的就诊年龄较偏小(F=7.93,P=0.019)。结论 TD+ADHD的患儿抽动障碍病情更为严重,但其严重程度却不受ADHD亚型的影响;TD+ADHD-HI与TD+ADHD-C患儿的早期行为问题更加突出且易被发现,因此更早地选择去医院就诊,但TD+ADHD-I患儿在就诊时其注意缺陷问题已经非常严重。
Abstract
Objective To analyze the clinical characteristics of tic disorders (TD) in children with and without attention deficit hyperactivity disorder (ADHD),in order to provide ideas for clinical treatment.Methods A total of 408 children aged 6 to 12 years old with TD-only and TD+ADHD were randomly selected from Pediatric Department,Guang'anmen Hospital,China Academy of Chinese Medical Sciences from June 2018 to November 2019,including 296 children with TD-only and 112 children with TD+ADHD.The differences on the incidence,such as disease course,clinical subtypes,onset age of TD,severity of TD between the two groups were compared,and the distribution of ADHD in TD+ADHD group were analyzed.Results In terms of Yale Global Tic Severity Scale(YGTSS) score and damage ratio,the TD+ADHD group was significantly higher than the TD alone group(t=-23.24,-19.17,P<0.001),which were not affected by the ADHD subtype.In TD+ADHD group,the score of attention-deficit subscale was significantly higher than that of hyperactivity/impulsivity (t=2.96,P＜0.05).The age of TD comorbid with hyperactivity/impulsiveness of ADHD (TD+ADHD-HI) and TD comorbid with the mixed of ADHD (TD+ADHD-C) was lower than that of TD comorbid attention-deficit of ADHD (TD+ ADHD-I) (F=7.93,P=0.019).Conclusions The condition is more serious in children with TD+ADHD,but the severity is not affected by the ADHD subtype.Moreover,compared with TD+ADHD-I,the early behavioral problems of TD+ADHD-HI and TD+ADHD-C are more prominent and easy to be early identified.However,the attention deficit of children with TD+ADHD-I is usually very serious when seeing doctors.
关键词
抽动障碍 /
抽动障碍共患注意力缺陷多动障碍 /
儿童
Key words
tic disorders /
tic disorder with attention deficit hyperactivity disorder /
children
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