盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的临床效果
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摘要
目的观察儿童注意缺陷多动障碍(ADHD)合并短暂性抽动障碍应用盐酸托莫西汀治疗的临床研究。方法采集2016年7月～2018年7月内蒙古自治区精神卫生中心门诊治疗的128例ADHD合并短暂性抽动障碍患儿,按不同治疗方案分为两组,每组64例。对照组服用盐酸哌甲酯治疗,观察组服用盐酸托莫西汀。比较两组疗效、认知功能及不良反应等多项指标。结果治疗2个月后,观察组总有效率高于对照组(P <0.05);治疗前两组各项Cormer因子评分比较,差异无统计学意义(P> 0.05),治疗后两组各项Cormer因子评分均较治疗前明显降低(P <0.05),且观察组学习、行为、焦虑等因子评分低于对照组(P <0.05);治疗前两组运动抽动、发声抽动评分比较,差异无统计学意义(P> 0.05),治疗后两组运动抽动、发声抽动评分均较治疗前降低(P <0.05),且观察组低于对照组(P <0.05);治疗前两组认知功能各项因子评分比较,差异无统计学意义(P> 0.05);治疗后两组认知功能各项因子评分均较治疗前升高(P <0.05),且观察组算数、编码、数字广度、C因子均高于对照组(P <0.05);观察组不良反应总发生率低于对照组(P <0.05)。结论 ADHD合并短暂性抽动障碍应用盐酸托莫西汀治疗效果显著,能有效改善ADHD,减轻抽动障碍,并纠正患儿认知功能,提高临床疗效,且不良反应少,安全有效。
Objective To observe the clinical treatment of children with attention deficit hyperactivity disorder(ADHD)complicated by transient tic disorder treated by Tomoxetine Hydrochloride. Methods The clinical data of 128 children with ADHD complicated by transient tic disorder who had received treatment in the Outpatient Service of Inner Mongolia Mental Health Center from July 2016 to July 2018 were enrolled in the study, and they were divided into two groups according to the different treatment options, with 64 cases in each group. The control group was treated with Methylphenidate Hydrochloride, whereas the observation group was treated with Tomoxetine Hydrochloride. The efficacy, cognitive function, adverse reactions and other indicators were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group after 2 months of treatment(P < 0.05). There were no statistical differences in the Cormer factor scores between the two groups before treatment(P >0.05), however, these scores were lower than before treatment in both groups(P < 0.05). The scores of learning, behavior, anxiety and other factors in the observation group were lower than those in the control group(P < 0.05). Before treatment, there was no statistical difference between the two groups in the scores of exercise twitch and vocal twitch(P >0.05), these scores were reduced in both groups after treatment(P < 0.05), and these scores in the observation group were lower than those in the control group(P < 0.05). There were no statistical differences in the scores of cognitive function between the two groups before treatment(P > 0.05); after treatment, however, the scores were increased than before treatment in both groups(P < 0.05). The counting, coding, digital breadth, and C factor in the observation group were higher than those in the control group(P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group(P < 0.05). Conclusion For children with ADHD complicated by transient tic disorder, Tomoxetine Hydrochloride is safe,effective and with significant curative effect, which can help improve ADHD, reduce tic disorder, correct cognitive function and enhance clinical efficacy, yet incurring fewer adverse reactions.
Objective To observe the clinical treatment of children with attention deficit hyperactivity disorder(ADHD)complicated by transient tic disorder treated by Tomoxetine Hydrochloride. Methods The clinical data of 128 children with ADHD complicated by transient tic disorder who had received treatment in the Outpatient Service of Inner Mongolia Mental Health Center from July 2016 to July 2018 were enrolled in the study, and they were divided into two groups according to the different treatment options, with 64 cases in each group. The control group was treated with Methylphenidate Hydrochloride, whereas the observation group was treated with Tomoxetine Hydrochloride. The efficacy, cognitive function, adverse reactions and other indicators were compared between the two groups. Results The total effective rate of treatment in the observation group was higher than that in the control group after 2 months of treatment(P < 0.05). There were no statistical differences in the Cormer factor scores between the two groups before treatment(P >0.05), however, these scores were lower than before treatment in both groups(P < 0.05). The scores of learning, behavior, anxiety and other factors in the observation group were lower than those in the control group(P < 0.05). Before treatment, there was no statistical difference between the two groups in the scores of exercise twitch and vocal twitch(P >0.05), these scores were reduced in both groups after treatment(P < 0.05), and these scores in the observation group were lower than those in the control group(P < 0.05). There were no statistical differences in the scores of cognitive function between the two groups before treatment(P > 0.05); after treatment, however, the scores were increased than before treatment in both groups(P < 0.05). The counting, coding, digital breadth, and C factor in the observation group were higher than those in the control group(P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group(P < 0.05). Conclusion For children with ADHD complicated by transient tic disorder, Tomoxetine Hydrochloride is safe,effective and with significant curative effect, which can help improve ADHD, reduce tic disorder, correct cognitive function and enhance clinical efficacy, yet incurring fewer adverse reactions.
引文
[1]张华,陈海丹,陈泽燕.儿童多动症患者发病危险因素及治疗效果分析[J].河北医药,2015,37(5):694-696.
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[5]方拴锋,朱晓华,叶蓓,等.盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(8):678-680.
[6]区建坤,徐谚.盐酸哌甲酯片在儿童多动症治疗中的效果分析[J].中国当代医药,2018,25(16):127-129.
[7]李俭俭,郑华城,刘振奎.可乐定透皮贴剂联合盐酸硫必利治疗儿童抽动障碍的疗效分析[J].脑与神经疾病杂志,2017,25(6):376-378.
[8]刘秀勤,李韵,陈丽清,等.WISC-Ⅳ与C-WISC诊断儿童智力障碍的一致性[J].中华行为医学与脑科学杂志,2017,26(1):51-54.
[9]Faraone SV,Biederman J,Monuteaux MC. Toward guidelines for pedigree selection in genetic studies of attention deficit hyperactivity disorder[J]. Genetic Epidemiology,2015,18(1):1-16.
[10]Dalsgaard S,?stergaard SD, Leckman JF,et al. Mortality in children,adolescents,and adults with attention deficit hyperactivity disorder:a nationwide cohort study[J].Lancet,2015,385(9983):2190-2196.
[11]Mcgoey KE,Schreiber J,Venesky L,et al. Factor Structure of Attention Deficit Hyperactivity Disorder Symptoms for Children Age 3 to 5 Years[J]. J Psychoeduc Assess,2015,33(5):392-394.
[12]Rubia K,Cubillo A,Woolley J,et al. Disorder-specific dysfunctions in patients with attention-deficit/hyperactivity disorder compared to patients with obsessive-compulsive disorder during interference inhibition and attention allocation[J]. Hum Brain Mapp,2015,32(4):601-611.
[13]Antshel KM,Barkley R. Psychosocial interventions in attention deficit hyperactivity disorder[J]. Child Adolesc Psychiatr Clin N Am,2015,24(1):79-97.
[14]纪小艺,吴敏.抽动障碍患儿治疗前后多巴胺D2受体与转运体mRNA的表达[J].中国当代儿科杂志,2016,18(4):297-300.
[15]Mataix-Cols D,Isomura K,Pérez-Vigil A,et al. Familial Risks of Tourette Syndrome and Chronic Tic Disorders:A Population-Based Cohort Study[J]. JAMA Psychiatry,2015, 72(8):787-793.
[16]Yael D,Vinner E,Izhar Bar-Gad. Pathophysiology of tic disorders[J]. Mov Disord,2015,30(9):1171-1178.
[17]陈敏,华丽,刘琳,等.盐酸哌甲酯控释片治疗儿童注意缺陷多动障碍疗效[J].医药导报,2015,34(10):1318-1321.
[18]屈小艳.盐酸哌甲酯控释片及静灵口服液治疗小儿多动症临床效果及安全性研究[J].中国现代医生,2016,54(26):94-96.
[19]朱小冰.小儿智力糖浆联合盐酸哌甲酯片治疗儿童注意缺陷多动障碍的疗效观察[J].现代药物与临床,2015,30(7):829-832.
[20]王洁英,郭向阳,李宏艳,等.盐酸哌甲酯辅助行为矫正治疗儿童注意缺陷多动障碍疗效评价[J].创伤与急危重病医学,2018,6(3):147-148.
[21]李瑾.盐酸哌甲酯控释片与盐酸托莫西汀治疗儿童注意缺陷多动障碍对比研究[J].中国现代药物应用,2016,10(24):56-57.
[22]朱舒虹,李思涛,符平.盐酸托莫西汀与盐酸哌甲酯治疗儿童注意缺陷多动障碍的对比研究[J].实用临床医药杂志,2016,20(17):95-97.
[23]唐敏,谭琼,黄瑛,等.利他林治疗对儿童多动症认知功能的影响[J].国际精神病学杂志,2017,44(2):240-242.
[24]Ono Y,Kikuchi M,Nakatani H,et al. Prefrontal oxygenation during verbal fluency and cognitive function in adolescents with bipolar disorder typeⅡ[J]. Asian J Psychiatr,2017,25:147-153.
[25]Berridge CW,Arnsten AF. Catecholamine mechanisms in the prefrontal cortex:proven strategies for enhancing higher cognitive function[J]. Curr Opin Behav Sci,2015,4:33-40.
[2]杨广娥.盐酸硫必利联合维生素B12对60例抽动障碍患儿神经功能及心理的影响[J].中国实用神经疾病杂志,2016,19(8):113-114.
[3]韦其松,侯晓诺,李俊明.盐酸哌甲酯缓释片治疗多动症处方点评[J].中国现代医药杂志,2017,19(2):97-98.
[4]陈方彦.CCMD-3中国精神障碍分类与诊断标准[M].济南:山东科学技术出版社,2001:87-88.
[5]方拴锋,朱晓华,叶蓓,等.盐酸托莫西汀治疗儿童多动症合并短暂性抽动障碍的临床疗效及安全性评价[J].中国临床药理学杂志,2016,32(8):678-680.
[6]区建坤,徐谚.盐酸哌甲酯片在儿童多动症治疗中的效果分析[J].中国当代医药,2018,25(16):127-129.
[7]李俭俭,郑华城,刘振奎.可乐定透皮贴剂联合盐酸硫必利治疗儿童抽动障碍的疗效分析[J].脑与神经疾病杂志,2017,25(6):376-378.
[8]刘秀勤,李韵,陈丽清,等.WISC-Ⅳ与C-WISC诊断儿童智力障碍的一致性[J].中华行为医学与脑科学杂志,2017,26(1):51-54.
[9]Faraone SV,Biederman J,Monuteaux MC. Toward guidelines for pedigree selection in genetic studies of attention deficit hyperactivity disorder[J]. Genetic Epidemiology,2015,18(1):1-16.
[10]Dalsgaard S,?stergaard SD, Leckman JF,et al. Mortality in children,adolescents,and adults with attention deficit hyperactivity disorder:a nationwide cohort study[J].Lancet,2015,385(9983):2190-2196.
[11]Mcgoey KE,Schreiber J,Venesky L,et al. Factor Structure of Attention Deficit Hyperactivity Disorder Symptoms for Children Age 3 to 5 Years[J]. J Psychoeduc Assess,2015,33(5):392-394.
[12]Rubia K,Cubillo A,Woolley J,et al. Disorder-specific dysfunctions in patients with attention-deficit/hyperactivity disorder compared to patients with obsessive-compulsive disorder during interference inhibition and attention allocation[J]. Hum Brain Mapp,2015,32(4):601-611.
[13]Antshel KM,Barkley R. Psychosocial interventions in attention deficit hyperactivity disorder[J]. Child Adolesc Psychiatr Clin N Am,2015,24(1):79-97.
[14]纪小艺,吴敏.抽动障碍患儿治疗前后多巴胺D2受体与转运体mRNA的表达[J].中国当代儿科杂志,2016,18(4):297-300.
[15]Mataix-Cols D,Isomura K,Pérez-Vigil A,et al. Familial Risks of Tourette Syndrome and Chronic Tic Disorders:A Population-Based Cohort Study[J]. JAMA Psychiatry,2015, 72(8):787-793.
[16]Yael D,Vinner E,Izhar Bar-Gad. Pathophysiology of tic disorders[J]. Mov Disord,2015,30(9):1171-1178.
[17]陈敏,华丽,刘琳,等.盐酸哌甲酯控释片治疗儿童注意缺陷多动障碍疗效[J].医药导报,2015,34(10):1318-1321.
[18]屈小艳.盐酸哌甲酯控释片及静灵口服液治疗小儿多动症临床效果及安全性研究[J].中国现代医生,2016,54(26):94-96.
[19]朱小冰.小儿智力糖浆联合盐酸哌甲酯片治疗儿童注意缺陷多动障碍的疗效观察[J].现代药物与临床,2015,30(7):829-832.
[20]王洁英,郭向阳,李宏艳,等.盐酸哌甲酯辅助行为矫正治疗儿童注意缺陷多动障碍疗效评价[J].创伤与急危重病医学,2018,6(3):147-148.
[21]李瑾.盐酸哌甲酯控释片与盐酸托莫西汀治疗儿童注意缺陷多动障碍对比研究[J].中国现代药物应用,2016,10(24):56-57.
[22]朱舒虹,李思涛,符平.盐酸托莫西汀与盐酸哌甲酯治疗儿童注意缺陷多动障碍的对比研究[J].实用临床医药杂志,2016,20(17):95-97.
[23]唐敏,谭琼,黄瑛,等.利他林治疗对儿童多动症认知功能的影响[J].国际精神病学杂志,2017,44(2):240-242.
[24]Ono Y,Kikuchi M,Nakatani H,et al. Prefrontal oxygenation during verbal fluency and cognitive function in adolescents with bipolar disorder typeⅡ[J]. Asian J Psychiatr,2017,25:147-153.
[25]Berridge CW,Arnsten AF. Catecholamine mechanisms in the prefrontal cortex:proven strategies for enhancing higher cognitive function[J]. Curr Opin Behav Sci,2015,4:33-40.