注意缺陷多动障碍儿童共患抽动障碍临床特征及影响因素分析  

Clinical features and risk factors of co-morbid tic disorder in children with attention deficit hyperactivity disorder

作　　者：周克英[1,2] 肖智辉 陈言钊[1,2] 张朝霞 刘智屏[1,2] 杨春何 高美好 

机构地区：[1]暨南大学第二临床医学院 [2]深圳市人民医院儿科,广东深圳518020 [3]深圳市儿童医院,广东深圳518026

出　　处：《中国当代儿科杂志》2014年第9期892-895,共4页Chinese Journal of Contemporary Pediatrics

基　　金：深圳市科技计划项目(200902015);深圳市知识创新计划项目(20140327234100)

摘　　要：目的分析注意缺陷多动障碍(ADHD)儿童共患抽动障碍(TD)的临床特征及影响因素。方法观察312名ADHD儿童共患TD情况,分析ADHD共患TD类型、不同亚型ADHD患儿的TD共患率,并对13个ADHD儿童共患TD的可能影响因素进行了单因素及多因素logistic回归分析。结果 312名ADHD儿童共患TD 42例(13.5%),ADHD混合型(ADHD-C)TD的共患率为24.1%,高于ADHD多动-冲动型(ADHD-HI,10.9%)和ADHD注意缺陷型(ADHD-I,8.8%)患儿(P<0.05)。共患TD类型为短暂性TD 21例(50.0%),慢性运动或发声TD 12例(28.6%),Tourette综合征(TS)9例(21.4%)。单因素分析显示沉溺手机或电脑游戏、不良饮食习惯、合并感染、家庭教育方式不当、父母亲间关系差、同学之间关系差等6个因素与ADHD共患TD有关。多因素logistic回归分析显示家庭教育方式不当、合并感染为ADHD共患TD的主要危险因素。结论 ADHD共患TD受多种因素影响,应早期针对主要的危险因素进行干预。Objective To study the clinical features and risk factors of co-morbid tic disorder（TD） in children with attention deficit hyperactivity disorder（ADHD）. Methods A total of 312 children with ADHD were involved in this study. Subtypes of co-morbid TD, incidences of TD in different subtypes of ADHD（ADHD-I, ADHD-HI and ADHD-C） were observed. Thirteen potential factors influencing the comorbidity rate of TD in ADHD were evaluated by univariate analysis and multiple logistic regression analysis. Results Forty-two of 312 children with ADHD suffered from co-morbid TD（13.5%）. Comorbidity rate of TD in children with ADHD-C（24.1%） was significantly higher than in those with ADHD-HI（10.9%） and ADHD-I（8.8%）（P〈0.05）. There were 21 cases（50.0%） of transient TD, 12 cases（28.6%） of chronic TD, and 9 cases（21.4%） of Tourette syndrome. The univariate analysis revealed 6 factors associated with comorbidity： addiction to mobile phone or computer games, poor eating habits, infection, improper family education, poor relationship between parents and poor relationship with schoolmates. Multiple logistic analysis revealed two independent risk factors for comorbidity： improper family education（OR=7.000, P〈0.05） and infection（OR=2.564, P〈0.05）. Conclusions The incidence of co-morbid TD in children with ADHD is influenced by many factors, and early interventions should be performed based on the main risk factors.

关 键 词：注意缺陷多动障碍 抽动障碍 临床特征 危险因素 儿童 

分 类 号：R749.94[医药卫生—神经病学与精神病学]