可乐定治疗共患注意缺陷多动障碍的抽动障碍患儿的临床疗效

目的:探讨可乐定治疗共患注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)的抽动障碍(tic disorder,TD)患儿的临床疗效。方法:对符合美国精神障碍诊断与统计手册第4版(DSM-IV)中TD和ADHD标准的儿童予系统的可乐定治疗,逐渐调整至目标剂量,并维持治疗12周。以耶鲁综合抽动严重程度量表(YGTSS)评定抽动症状;根据家长填写的ADHD评定量表(ADHD-RS-IV)评定注意缺陷多动症状;并观察药物不良反应。结果:本研究完成系统可乐定滴定并维持治疗12周的共患ADHD的TD患儿40例,男36例,女4例;年龄6.50～14.50(9.84±2.90)岁。完成剂量滴定患儿的目标剂量5μg/(kg.d),最大剂量不超过0.2 mg/d。治疗后抽动总分(9.78±7.76)分,运动抽动分(7.52±4.85)分,发声抽动分(2.26±3.27)分,功能受损程度评分(8.50±5.70)分;治疗前抽动总分(21.34±8.66)分,运动抽动分(15.41±4.68)分,发声抽动分(5.93±7.10)分,功能受损程度评分(21.16±11.76)分。治疗后运动抽动及发声抽动的数量、频度、强度和复杂性均较治疗前显著减少(P<0.05)。治疗后ADHD总分(12.63±9.07)分,注意缺陷评分(7.43±4.74)分,多动-冲动评分3.0分;治疗前ADHD总分(31.05±8.51)分,注意缺陷评分(17.55±3.08)分,多动-冲动评分13.0分。治疗后家长ADHD症状评定量表总分及分量表分较治疗前均显著下降(P<0.05)。结论:可乐定治疗共患ADHD的TD患儿的运动抽动、发声抽动、注意力缺陷、多动-冲动均有明显疗效,能改善患儿生活质量。

Therapeutic Effects of Clonidine on Children with Comorbid Tic Disorder and Attention Deficit Hyperactivity Disorder

Objective:To explore the therapeutic effects of clonidine on children with comorbid tic disorder(TD) and attention deficit hyperactivity disorder(ADHD).Methods: The children who met the criteria of Mental Disorder Diagnostic and Statistical Manual for TD and ADHD were given systematic clonidine titration reaching the target dose and were treated for 12 weeks.Symptoms of TD and ADHD were evaluated respectively with Yale Global Tic Severity Scale(YGTSS) and ADHD rating scale-Ⅳ(ADHD-RS-Ⅳ) for parents.Results: There were forty children with comorbid TD and ADHD(36 males,4 females;age range 6.50~14.50 years,mean age 9.84±2.90 years),who had completed systemic titration in the study.The target dose was 5 μg/(kg·d) and the maximum dose was <200 mg/d.The number,frequency,intensity,and complexity of motor and vocal tics were reduced significantly.The scores of total tics(9.78±7.76),motor tics(7.52±4.85),vocal tics(2.26±3.27) and impairment of functions(8.50±5.70) of YGTSS decreased significantly after treatment compared with those before treatment(matching scores: 21.34±8.66,15.41±4.68,5.93±7.10 and 21.16±11.76 scores,respectively,P<0.05).The total score of ADHD(12.63±9.07),inattention score(7.43±4.74) and hyperactivity/impulsivity score(3.0) of ADHD-RS-Ⅳ decreased significantly after treatment compared with those before treatment(31.05±8.51,17.55±3.08,and 13.0 scores,respectively,P<0.05).Conclusions: Clonidine has good clinical effect on children with comorbid TD and ADHD including motor tics,vocal tics,inattention and hyperactivity/impulsivity,and can improve the quality of life.