CAJ | 학술논문

目的:了解学龄儿童抽动障碍(tic disorders,TD)致病的危险因素,探索早期干预方法.方法:采用分层整群随机抽样法,从大兴区41597名小学生和20239名初中生中抽取4020名学生进行TD的横断面调查.采用自编抽动障碍初筛问卷和一般情况调查表收集学生临床资料,对筛查阳性者及老师或同学报告有类似症状者进行面谈和临床评估,采用美国<精神障碍诊断与统计手册>第四版中TD标准进行诊断和分类,最终查出TD患儿(病例组)86例.抽取与病例组年龄、性别和年级相匹配的TD阴性者86例为对照组.通过电话访谈来确定家族中的TD可疑病例,然后对可疑病例进行面访以排除或确诊TD.采用自编定式病历表调查与抽动症发病相关的因素.结果:抽动症家族史(7.0%)、剖腹产史(如86例TD患者中,剖腹产出生者31例,占36.0%)、碳酸饮料(10.5%)、肥胖(14.0%)和病前心理应激是TD发病的危险因素(均P＜0.05).多因素方差分析显示,抽动症家族史、分娩方式、居住环境、碳酸饮料、亲子关系紧张、兴趣爱好少、学习成绩差、自理能力差均与TD有关(P均＜0.05).结论:儿童抽动障碍起病可能是由多因素相互作用的结果,早期干预是重要的.
목적:료해학령인동추동장애(tic disorders,TD)치병적위험인소,탐색조기간예방법.방법:채용분층정군수궤추양법,종대흥구41597명소학생화20239명초중생중추취4020명학생진행TD적횡단면조사.채용자편추동장애초사문권화일반정황조사표수집학생림상자료,대사사양성자급로사혹동학보고유유사증상자진행면담화림상평고,채용미국<정신장애진단여통계수책>제사판중TD표준진행진단화분류,최종사출TD환인(병례조)86례.추취여병례조년령、성별화년급상필배적TD음성자86례위대조조.통과전화방담래학정가족중적TD가의병례,연후대가의병례진행면방이배제혹학진TD.채용자편정식병력표조사여추동증발병상관적인소.결과:추동증가족사(7.0%)、부복산사(여86례TD환자중,부복산출생자31례,점36.0%)、탄산음료(10.5%)、비반(14.0%)화병전심리응격시TD발병적위험인소(균P＜0.05).다인소방차분석현시,추동증가족사、분면방식、거주배경、탄산음료、친자관계긴장、흥취애호소、학습성적차、자리능력차균여TD유관(P균＜0.05).결론:인동추동장애기병가능시유다인소상호작용적결과,조기간예시중요적.
Objective:To understand the related factors of tic disorders(TD) and early intervention among schoolchildren.Methods:Using stratified-cluster random sampling techniques,4,020 children were selected from 61,836 schoolchildren in Daxing district of Beijing.Totally 4,020 children and their parents were asked to fill in a self-designed questionnaire covering both motor and vocal tics and general information.A three-stage procedure was used:screening,interview and clinical investigation.A total of 3,813 children were investigated successfully.The children who were reported with tic symptoms as well as those who were reported by their teachers or classmates were surveyed according to the TD criteria in Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition(DSM-Ⅳ).Eighty-six TD children were investigated respectively about the related factors of TD,and 86 healthy children matched in age,sex and grade were selected as controls.Telephone interview was carried out to find the doubtful TD cases in family members.Those people identified as having tics underwent a semistructured interview to determine whether they had TD according to DSM-Ⅳ criteria.Related risk factors of TD were investigated according to self-designed formulary medical history sheet. Results:Positive TD inheritance family history(7.0%),abdominal delivery style(36.0%),carbonate drink(10.5%),obesity(14.0%) and psychological stress were risk factors of TD(P<0.05).The multivariate analysis of variance indicated that inheritance family history,delivery style,dwelling environment,carbonate drink,parent-child relation,hobby,underachieve,self-care ability were closely related to the high incidence of TD (P<0.05).Conclusion:The occurrence of tic disorders may be related to multiple interacted factors.Early intervention is most important.