关键词: 抽动障碍, 成年, 预后, 危险因素, 儿童期治疗指导

Abstract: Background Tic disorder (TD) is a childhood-onset disease. Some TD patients even suffer from tic-related injuries in adulthood. Objective To investigate the proportion of children with TD who still have tic symptoms in adulthood, and analyze the influencing factors of prognosis of adults with childhood-onset TD. Design Case-control study. Methods Telephone follow-up was conducted for adults who were diagnosed as TD in children in the pediatric outpatient department of Guang'anmen Hospital, China Academy of Chinese Medical Sciences. The patients with home contact numbers recorded in the medical records system and YGTSS rating on initial visit were considered. We divided the patients into a case group and a control group according to whether they still had tic symptoms in adulthood. Based on the self-made follow-up questionnaire, we investigated the influencing factors of TD in the follow-up population. The questionnaire had two parts of medical history and follow-up information. Contents of medical records included gender, date of birth, telephone number, age of first TD, first symptom, YGTSS score at first diagnosis and the follow-up information referred to history of childhood respiratory inflammation, family education style, parents＇ personality, family history of TD, comorborbity, Chinese medicine treatment and adjuvant therapy, current treatment status, current education level, TD symptoms at the stop of the treatment before the age of 18, and TD-related symptoms in adulthood (if there were symptoms, YGTSS score was performed and compared with the initial diagnosis in childhood). Single-factor analysis and binary logistic regression analysis were used to analyze the influencing factors. Main outcome measures Influencing factors of prognosis of adults with childhood-onset TD. Results Telephone follow-up was completed in 534 TD patients, with 262 (49. 1%) in the case group and 272 in the control group. Children were treated mainly with traditional Chinese medicine combined with western medicine and other treatments. Thirty-one TD adults (11.8%) were still receiving treatment at the time of follow-up. Compared with childhood, 80.2%, 6.5% and 0.8% of adult patients had remission, similarity and aggravation, respectively, and 33 cases had relapse in adulthood. The YGTSS scores of TD adults were 93.1%, 5.7%, and 1. 2%, respectively. Univariate logistic regression analysis showed that statistically significant independent variables entered the multivariate logistic regression analysis of adult prognostic factors. Multivariate logistic regression analysis showed there were five risk factors for the prognosis of adults with childhood-onset TD, including symptoms occurring at the stop of treatment in childhood (OR=20.35, 95%CI: 12.30-33.68), family history of TD (OR=3.54, 95%CI: 1.40-8.96), irritable parents (OR=3.13, 95%CI: 1.74-5. 64), moderate to severe disease at initial diagnosis in childhood (OR=2.91, 95%CI: 1.79-4.75), and recurrent respiratory tract inflammation (OR=2.34, 95%CI: 1.41-3.86). Conclusion The prognosis of adults with childhood-onset TD is closely related to the family history of TD, the severity of the disease in childhood, the severity at initial diagnosis in childhood, tic symptoms at the stop of treatment in childhood, recurrent respiratory tract inflammation in childhood, and the personality of parents.

Key words: Tic disorder, Adulthood, Prognosis, Risk factors, Guidance for treatment in juveniles