摘要
目的研究A族β溶血性链球菌(group Aβ-streptococcal,GAS)感染与儿童抽动障碍(tic disorder,TD)相关性及分析苄星青霉素临床疗效。方法纳入2017年6月至2020年10月广州妇女儿童医疗中心就诊TD患儿为研究对象,抗链球菌溶血素(anti-streptolysin,ASO)升高者为302例(TD1组,疑似感染GAS),ASO正常为189例(TD2组)。TD1组包括短暂性TD(transient tic disorder,TTD)183例,慢性TD(chronic tic disorder,CTD)72例及Tourette综合征(Tourette syndrome,TS)47例。对比TD1组及TD2组性别、年龄、TTD、CTD、TS、注意力缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)、睡眠障碍(sleep disorder,SD)、强迫症(obsessive-compulsive disorder,OCD)、情绪障碍(emotional handicap,ED)、遗尿、啃指甲、拔毛、近期呼吸道感染、腺体肥大等特征差异。治疗Ⅰ:对照组予硫必利治疗,治疗组予硫必利+苄星青霉素治疗,以耶鲁综合抽动严重程度量表(Yale comprehensive tic severity scale,YGTSS)评估治疗前后分值,对比疗效。治疗Ⅱ:对ASO>800 IU/L、接受硫必利+可乐定透皮贴和(或)托吡酯治疗无效TD1组患儿,加用苄星青霉素1年,对比疗效。结果TD1组CTD、TS、ADHD、ED、SD、遗尿、啃指甲或拔毛、近期呼吸道感染、腺体肥大发生率均高于TD2组,差异均具统计学意义(P<0.05)。治疗Ⅰ:YGTSS减分[治疗组(10.083±4.862)分>对照组(4.358±3.806)分]和有效率[治疗组(89.17%)>对照组(43.92%)]差异均具统计学意义(P<0.01)。治疗Ⅱ:YGTSS分值[治疗前(19.182±5.229)分>半年(8.030±4.753)分>1年(4.483±3.101)分]和ASO[1年后(315.625±175.665)U/L<治疗前(1209.579±498.232)U/L]差异均具统计学意义(P<0.01)。结论GAS感染可能参与TD发生发展,使神经精神异常行为多样化,考虑应用苄星青霉素治疗链球菌相关TD效果较佳。
Objective To study the correlation between group A β-streptococcal(GAS)infection and tic disorder(TD)in children and to analyze the clinical efficacy of benzathine penicillin.Methods Children with TD who were treated in Guangzhou Women and Children's Center from June 2017 to October 2020 were included as the research objects,of which 302 cases(TD1 group,suspected GAS infection)had elevated anti-streptolysin(ASO)and 189 cases(TD2 group)had normal ASO.TD1 group included 183 children with transient TD(TTD),72 children with chronic TD(CTD)and 47 children with Tourette syndrome(TS).Sex,age,TTD,CTD,TS,attention deficit hyperactivity disorder(ADHD),sleep disorder(SD),obsessive-compulsive disorder(OCD),emotional disorder(ED),enuresis,nail biting,hair plucking,recent respiratory tract infection and glandular hypertrophy were compared between TD1 group and TD2 group.TreatmentⅠ:the control group was treated with tiapride,the treatment group was treated with tiapride+benzathine penicillin.The Yale comprehensive tic severity scale(YGTSS)scores were calculated before and after treatment and the curative effects were compared.TreatmentⅡ:children in TD1 group with ASO>800 IU/L and had ineffective treatment with tiapride+clonidine transdermal patch and/or topiramate were treated with benzathine penicillin for 1 year,and the efficacy was compared.Results The incidence of CTD,TS,ADHD,ED,SD,enuresis,nail biting or hair plucking,recent respiratory tract infection and gland hypertrophy in TD1 group were higher than those in TD2 group,with statistical significance(P<0.05).TreatmentⅠ:YGTSS score reduction[treatment group(10.083±4.862)>control group(4.358±3.806)]and the effective rate[treatment group(89.17%)>control group(43.92%)]in the treatment group were significant difference compared with those in the control group(P<0.01).TreatmentⅡ:YGTSS score[before treatment(19.182±5.229)>half a year(8.030±4.753)>1 year(4.483±3.101)]and ASO[1 year later(315.625±175.665)U/L<(1209.579±498.232)U/L before treatment]before treatment were significant difference compared with those 1 year later(P<0.01).Conclusion GAS infection may participate in the occurrence and development of TD,which could lead to diversify neuropsychiatric abnormal behaviors.Benzathine penicillin is considered to be more effective in the treatment of streptococcal related TD.
作者
杨喆
张松
黄斌
林芬
曾华松
YANG Zhe;ZHANG Song;HUANG Bin;LIN Fen;ZENG Huasong(Department of Pediatrics,Chaozhou Central Hospital Affiliated to Southern Medical University,Chaozhou 521021,Guangdong Province,China;Department of Epidemiology,Guangzhou Women and Children's Medical Center,Guangzhou 510000,Guangdong Province,China;Central Laboratory,Chaozhou Central Hospital Affiliated to Southern Medical University,Chaozhou 521021,Guangdong Province,China)
出处
《世界临床药物》
2021年第10期892-896,918,共6页
World Clinical Drug
关键词
儿童
链球菌感染相关抽动障碍
苄星青霉素
临床分析
children
group Aβ-streptococcal infection associated tic disorder
benzathine penicillin
clinical analysis
