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

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。

Abstract:

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). Conclusion 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.