摘要
目的 探讨儿童抽动障碍(tic disorders,TD)的诊断与评估现状,为综合防治儿童抽动障碍提供理论依据.方法 对1999年1月至2008年12月在青岛大学医学院附属医院儿童保健科就诊的2002例抽动障碍患者的性别、发病年龄、诊断与评估等进行回顾性分析.结果 (1)10年间TD病例资料完整者2002例,其中男性1608名,女性394名,男∶女为4.08:1,发病年龄10个月至21岁,3～9岁为发病高峰；(2)TTD组471例,19.11％ (90/471)合并共病,ADHD、OCD、焦虑症分别占14.65％ (69/471)、5.31％ (25/471)、3.18％(15/471)；67.52％(318/471)首发症状为简单运动性抽动,57.96％(273/471)表现为眼部症状.CTD组689例,63.86％ (440/689)合并共病,ADHD、OCD、焦虑症分别占51.38％(354/689)、20.32％(140/689)、11.76％(81/689)；66.91％(461/689)首发症状为简单运动性抽动,68.21％(470/689)表现为眼部症状.TS组842例,74.23％(625/842)合并共病,ADHD、OCD、焦虑症分别占57.96％(488/842)、25.06％(211/842)、23.75％(200/842)；81.47％(686/842)首发症状为简单发声性抽动,88.95％(749/842)表现为清嗓；(3)儿童抽动障碍既往诊疗过程中,3种类型的误诊率分别为58.82％(70/119),55.07％(125/227),34.76％ (162/466).3组各有226例(47.98％,226/471)、211例(30.62％,211/689)、200例(23.75％,200/842)患者未曾复诊.(4)初诊确定诊断者98.20％(1966/2002).既往诊疗过程中定量评估抽动严重程度者0.99％(8/812),评估共病ADHD者37.68％(306/812),未见进行OCD评估者；在本院诊疗中评估抽动严重程度者10.54％(211/2002),评估共病ADHD者61.19％ (1225/2002),评估OCD者33.57％(672/2002).结论 TD可以2岁以内发病,高峰发病年龄3～9岁,较文献报道提前；男性患病率明显高于女性.抽动症状形式多样,最常见于眼部症状、清嗓,易造成误诊；普遍存在共病现象,ADHD、OCD、焦虑症为最常见的3种.诊断过于草率,复诊不规范,症状严重程度定量和共病评估少.
Background Tic disorders( TD) is a childhood onset neuropsychiatric disorder characterized by single or multiple motor tics or vocal / phonic tics. To date,the etiology and pathogenesis of TD is not definite. Tic symptoms and comorbidities seriously harm physical and mental health in children.Objective To summarize the clinical characteristics,diagnosis and assessment of tic disorders in children so as to provide theoretical evidence for comprehensive prevention and treatment of TD. Methods A total of2002 TD cases were enrolled from 1999 to 2008 in the Children Health Care Department of the Affiliated Hospital of Medical College,Qingdao University. All cases were analyzed retrospectively. Results( 1) There were 2002 cases children with TD in total. Male VS. female was 4. 08∶ 1( 1608∶ 394). The onset age were from 10 months to 21 years old. The peak onset age of TD ranged from 3 to 9 years old.( 2) There were 471 cases of transient tic disorders( TTD). 90 patients had comorbidities. Attention deficit hyperactivity disorder( ADHD),obsessive-compulsive disorder( OCD),anxiety disorders accounted for 14. 65%,5. 31%,3. 18%,respectively. 67. 52%( 318 /471) of patients had simple motor tics as the initial symptom,and57. 96%( 273 /471) patients presented eye blinking. There were 689 cases of chronic tic disorders( CTD).440 patients had comorbidities. ADHD,OCD,anxiety disorders accounted for 51. 38%,20. 32%,11. 76%,respectively. 66. 91%( 461 /689) of patients had simple motor tics as the initial symptom,68. 21%( 470 /689)presented eye blinking. There were 842 cases of Tourette syndrome( TS). 625 patients had comorbidities.ADHD,OCD,anxiety disorders were accounted for 57. 96%,25. 06%,23. 75%,respectively. 81. 47%( 686 /842) of patients had simple phonic tics as the initial symptom,88. 95%( 749 /842) presented throat clearing.( 3) The misdiagnosed rate of three types were 58. 82%( 70 /119),55. 07%( 125 /227),34. 76%( 162 /466) separately during previous diagnosis and treatment. 226( 48. 0%,226 /471),211( 30. 6%,211 /689),200( 23. 8%,200 /842) children had never further consultation with a doctor.( 4) 98. 20%( 1966/2002) children were diagnosed as TD preliminarily. The symptoms severity degree of 0. 99%( 8/812)children were assessed during previous diagnosis and treatment,37. 68%( 306 /812) children were assessed with ADHD,No children were assessed with OCD; The symptoms severity degree of 10. 54%( 211 /2002)children were assessed,61. 19%( 1225 /2002) children were assessed with ADHD,33. 57%( 672 /2002)children were assessed with OCD when they came to our hospital. Conclusions The onset age and the peak onset age of TD emerged more earlier than before. The prevalence in male was significantly higher than that in female. The cardinal symptoms were eye blinking and throat clearing. The misdiagnosed rate of TD was high. It was common in patients with comorbidities,ADHD,OCD,anxiety disorders were the main three types. Assessment of symptoms severity degree and comorbidity were often absent. These results showed that there were lots of problems in diagnosis and assessment of TD.
出处
《中华诊断学电子杂志》
2013年第1期-,共5页
Chinese Journal of Diagnostics(Electronic Edition)
基金
国家自然科学基金(81101017)
关键词
抽动性运动障碍
诊断
注意力缺陷障碍伴多动
强迫性障碍
Tic disorders
Diagnosis
Attention deficit disorder with hyperactivity
Obsessive-compulsive disorder
