中药联合妥泰治疗Tourette综合征的临床疗效观察
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摘要
目的:观察中药联合妥泰治疗Tourette综合征的效果。
方法:采用非盲法随机对照试验研究设计方案,将40例Tourette综合征患儿随机分为试验组和对照组两组。两组基础治疗相同,试验组加以妥泰及清热化痰、熄风开窍中药,对照组仅加以妥泰治疗。观察两组治疗前、治疗后2周、4周复诊时临床疗效及其相关副反应情况,根据耶鲁抽动程度量表对每一例患儿病情予以评分,并进行统计学分析。
结果:治疗组完全缓解3例,显效11例,有效6例,无效0例,总有效率100%;对照组完全缓解O例,显效1例,有效11例,无效8例,总有效率60%。治疗组疗效明显优于对照组。
治疗14天后,两组病情都得到一定改善,其中治疗组疗效优于对照组。治疗28天后,两组病情改善良好,两组相比较,治疗组疗效明显优于对照组。
副反应情况:服药过程中,对照组1例出现胸闷,未予特殊处理,自行缓解;5例出现汗少、低热;3例出现食欲减退。治疗组未发生明显副反应发生,试验过程中0例受试者退出。
结论:
通过临床非盲法随机对照试验研究,中西药联合治疗与单用西药治疗方法相比,前者更能有效控制Tourette综合征的临床症状,缩短治疗时间,且治疗中未发生明显副反应,疗效确切。其作为多发性抽动症临床治疗的一种行之有效方法,可在临床治疗过程中加以推广使用。
Objective: To observe the clinical effect of Chinese medicine and Topiramate in the treatment of Tourette syndrome.
Method: Randomly, no-blind, comparative designs were taken in this study. Forty children with Tourette syndrome were divided randomly and averagely into the treatment group and the control group. The treatment group was treated with both Chinese medicine and topiramate, and the control group was treated with only topiramate (both groups with the same basic treatment). We evaluated the clinical effect of the two groups by recording YGTSS before, 2 weeks and 4 weeks after treatment. All data were analyzed with SPSS 14.0.
Result: There was three completed remission cases, eleven effectual cases, six effective cases, no ineffective case in the treatment group, and the total effective rate of treatment group is100%; while there was no completed remission case, one effectual case, eleven effective cases, eight ineffective cases in the treatment group, and the total effective rate of control group is 60%. The total effective rate of treatment group is obviously higher than that of the control group (P<0.05).
All the cases have made some improvement 14 days after treatment, while the treatment group was better than the control group. Both two groups had been greatly improved 28 days after treatment, while the treatment group was more superior to the control group.
Side effects in the course of treatment in the control group, one child felt rather tight; 5 children had less sweat, and even had a slight fever; 3 children had anorexia. No obvious side effect was observed in the treatment group.
Conclusion: Through the random, no-blind, comparative clinical design, it suggested that Chinese medicine combined with topiramte is a well-proven method in controlling symptoms of Tourette syndrome. Besides, no more obvious side effect was observed, and maybe a useful way to treat Tourette syndrome.
方法:采用非盲法随机对照试验研究设计方案,将40例Tourette综合征患儿随机分为试验组和对照组两组。两组基础治疗相同,试验组加以妥泰及清热化痰、熄风开窍中药,对照组仅加以妥泰治疗。观察两组治疗前、治疗后2周、4周复诊时临床疗效及其相关副反应情况,根据耶鲁抽动程度量表对每一例患儿病情予以评分,并进行统计学分析。
结果:治疗组完全缓解3例,显效11例,有效6例,无效0例,总有效率100%;对照组完全缓解O例,显效1例,有效11例,无效8例,总有效率60%。治疗组疗效明显优于对照组。
治疗14天后,两组病情都得到一定改善,其中治疗组疗效优于对照组。治疗28天后,两组病情改善良好,两组相比较,治疗组疗效明显优于对照组。
副反应情况:服药过程中,对照组1例出现胸闷,未予特殊处理,自行缓解;5例出现汗少、低热;3例出现食欲减退。治疗组未发生明显副反应发生,试验过程中0例受试者退出。
结论:
通过临床非盲法随机对照试验研究,中西药联合治疗与单用西药治疗方法相比,前者更能有效控制Tourette综合征的临床症状,缩短治疗时间,且治疗中未发生明显副反应,疗效确切。其作为多发性抽动症临床治疗的一种行之有效方法,可在临床治疗过程中加以推广使用。
Objective: To observe the clinical effect of Chinese medicine and Topiramate in the treatment of Tourette syndrome.
Method: Randomly, no-blind, comparative designs were taken in this study. Forty children with Tourette syndrome were divided randomly and averagely into the treatment group and the control group. The treatment group was treated with both Chinese medicine and topiramate, and the control group was treated with only topiramate (both groups with the same basic treatment). We evaluated the clinical effect of the two groups by recording YGTSS before, 2 weeks and 4 weeks after treatment. All data were analyzed with SPSS 14.0.
Result: There was three completed remission cases, eleven effectual cases, six effective cases, no ineffective case in the treatment group, and the total effective rate of treatment group is100%; while there was no completed remission case, one effectual case, eleven effective cases, eight ineffective cases in the treatment group, and the total effective rate of control group is 60%. The total effective rate of treatment group is obviously higher than that of the control group (P<0.05).
All the cases have made some improvement 14 days after treatment, while the treatment group was better than the control group. Both two groups had been greatly improved 28 days after treatment, while the treatment group was more superior to the control group.
Side effects in the course of treatment in the control group, one child felt rather tight; 5 children had less sweat, and even had a slight fever; 3 children had anorexia. No obvious side effect was observed in the treatment group.
Conclusion: Through the random, no-blind, comparative clinical design, it suggested that Chinese medicine combined with topiramte is a well-proven method in controlling symptoms of Tourette syndrome. Besides, no more obvious side effect was observed, and maybe a useful way to treat Tourette syndrome.
引文
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[2]Como PG.Neuropsychological function in Tourette's syndrome[J],Adv Neurol,2001,85:103-111
[3]钱连华,华于静.Tourette综合征患者9-12年随访研究[J],中国神经精神疾病杂志,1996,22(6):357-358
[4]吴家骅.DSM-Ⅳ-R关于抽动障碍的分类与诊断标准[J].中华儿科杂志,1996,34(5):352
[5]刘智胜.小儿多发性抽动症[M].第1版.北京:人民卫生出版社.2002:151-153.
[6]钟佑泉,吴惧,谢晓丽等.耶鲁抽动症整体严重度量表对抽动患儿的临床评估[J],中国实用儿科杂志,2006,21(3):214-216
[7]吴家骅.抽动障碍的分类、诊断及病情严重程度评估[J],中国实用儿科杂志,2002,17(4):196-197
[8]黄宇虹,刘晋平.马融.辨证分型治疗抽动障碍的临床观察[J],天津中医药,2003,20(2),76-77
[9]刘大为,张骠.滋肾平肝、熄风化痰法治疗小儿多发性抽动症18例报道[J],甘肃中医,2005,18,6,14-15
[10]王文革,孟宪军.汪受传治疗小儿多发性抽动症的经验[J],辽宁中医杂志,2004,31,3,181-182
[11]刘弼臣.小儿抽动-秽语综合征治疗经验[J],中国中医药现代远程教育,2004,2(7),19-21
[12]韦俊,黄燕萍,何平.中医辨证治疗小儿多发性抽动症120例[J],中华现代儿科学杂志,2005,2,11,1030-1031
[13]孙巧,张宝田,马英等.多动秽语综合征的临床诊断与中西医结合治疗[J],中华国际医学杂志,2003,3(6):553-554
[14]东兰,李宜瑞.李宜瑞教授治疗儿童抽动-秽语综合征经验述要[J],中医药学刊,2004,22,7,1176
[15]金嵘,郑荣远,林永志等.Tourette综合征危险因素的病因分值和交互作用研究[J],中国公共卫生,2001,17(7),593-594
[16]Peterson RS,Thomas P,Kane MJ,et al.Basal Ganglia volumes in patients with Gilles de la Tourette syndrome[J].Arch Gen Psychiatry,2003;60(4):415-424
[17]Kim KJ,Peterson BS.Cavum septi pellucidi in Tourette syndrome[J],Bid Psychiatry,2003,54(1):76-85
[18]文霞.Tourette综合征神经递质研究进展[J],国外医学神经病学神经外科学分册,1997,24:142
[19]史玉泉.实用神经病学[M].第2版.上海:科学技术出版社,2000,786
[20]Budman CL,Kerjakovic M,Bruun RD.Viral infection and tic exacerbation[J].J Am Acad Child Adolesc Psychiatry,1997,36:162
[21]Riedel M,Straube A,Schwarz MJ,et al.allme disease presenting as Tourette's syndrome [J].Lancet,1998,351:418-9
[22]Norbert M,Riedel M,Stefanie F,et al.Tourette's syndrome and mycoplasma pneumoniae infection [J].Am J Psychiatry,2000,157:481-482
[23]Muller N,Riedel M,Straube A,et al.Increased anti-streptococcal antibodies fin patients with Tourette's syndrome[J].Psychiatry Res,2000,94:43-49
[24]Muller N,Kroll B,Schwarz MJ,et al.Increased titers of antibodies against streptococcal M12 and M19 proteins in patiets with Tourette's syndrome[J].Psychiatry Res,2001;101:187-193
[25]Perlmutter SJ,Garvey MA,Castellanos X,et al.A case of pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections[J].Am J Psychiatry,1998,155:1592-1598
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