CAJ | 학술논문

目的总结首诊于眼科的抽动障碍(TD)的临床特征及其被误诊或漏诊的原因.方法分析2009年2～11月以"眨眼"为主诉首诊于眼科618例患者中诊断为TD患者的临床资料.结果 (1)最终诊断为TD者187例,占"眨眼"为主诉患儿的30.3%,男女均列为4.2:1,其中短暂性抽动(TTD)102例(54.5%),慢性抽动(CTD)62例(33.2%),多发性抽动(TS)23例(12.3%).(2)主诉为单纯眨眼123例(65.8%),伴眼部其他不适64例(34.2%);78例(41.7%)眼部无阳性体征,67例(35.8%)有结膜充血、滤泡或乳头,42例(22.5%)伴有眼部其他体征;全部以运动抽动首发,37例伴发声抽动;抽动部位主要位于头面部(73.7%),抽动形式主要为简单抽动(91.7%);合并有精神损害47例(25.1%),其中35例为ADHD.(3)误诊情况:243例有外院就诊史的"眨眼"患者最终被诊断为TD81例,其中58例漏诊或误诊(23.9%).结论 (1)抽动障碍是异常眨眼的主要原因之一.(2)首诊于眼科的TD多为TTD,抽动部位多位于头面部,以运动抽动为主,抽动形式主要为简单抽动;合并精神行为损害较少.(3)首诊于眼科的TD可合并眼部器质性病变同时存在;(4)误诊的原因主要是眼科医生认识混乱以及病情较轻,易被忽视所致;而与眼部器质性病变同时存在则是漏诊的主要原因.
목적 총결수진우안과적추동장애(TD)적림상특정급기피오진혹루진적원인.방법 분석2009년2～11월이"잡안"위주소수진우안과618례환자중진단위TD환자적림상자료.결과 (1)최종진단위TD자187례,점"잡안"위주소환인적30.3%,남녀균렬위4.2:1,기중단잠성추동(TTD)102례(54.5%),만성추동(CTD)62례(33.2%),다발성추동(TS)23례(12.3%).(2)주소위단순잡안123례(65.8%),반안부기타불괄64례(34.2%);78례(41.7%)안부무양성체정,67례(35.8%)유결막충혈、려포혹유두,42례(22.5%)반유안부기타체정;전부이운동추동수발,37례반발성추동;추동부위주요위우두면부(73.7%),추동형식주요위간단추동(91.7%);합병유정신손해47례(25.1%),기중35례위ADHD.(3)오진정황:243례유외원취진사적"잡안"환자최종피진단위TD81례,기중58례루진혹오진(23.9%).결론 (1)추동장애시이상잡안적주요원인지일.(2)수진우안과적TD다위TTD,추동부위다위우두면부,이운동추동위주,추동형식주요위간단추동;합병정신행위손해교소.(3)수진우안과적TD가합병안부기질성병변동시존재;(4)오진적원인주요시안과의생인식혼란이급병정교경,역피홀시소치;이여안부기질성병변동시존재칙시루진적주요원인.
Objective To determine the clinical characteristics and the causes of misdiagnosis or missed diagnosis with tic disorders first-consultation in department of ophthalmology. Methods All 618 consecutive patients in children less than 16 years of age who had excessive blinking as their sole or major chief complaint underwent detailed history and ophthalmologic examination. Results (1) TD was diagnosed 187 of 61 g cases, the percentage was 30.3%, boys outnumbered girls at a ratio of 4.2:1, 102 patients had transient tic disorders (TTD), 62 had chronic tic disorders (CTD), and 23 had Tourette's syndrome (TS). (2) 123 patients (65.8%) had only eye tics as their chief complaint, and the other had others complaints with eye; 78 patients (41.7%) had no any organic eye pathology, 67 had conjunctival injection, follicle and papilla, 42 had others eye abnormalities; all patients had motor tics, only 37 had vocal tics; 171 patients had simple tics, mainly facial tic;and 47 patients had a variety of neurobehavioral symptoms, mainly associated with ADHD. (3) 58 of 8l cases who had consulted in other department of ophthalmology were been misdiagnosis or missed diagnosis. Conclusions TD is the common cause in children with excessive blinking. The clinical characteristics is manifested in a spectrum of main type of TTD, simple motor tics, main facial tic, a few of neurobehavioral disturbances and coexisting organic eye pathology. Ophthalmologists have few knowledge and neglect of it and coexistence of organic eye pathology are the main causes of misdiagnosis.