中国儿童抽动障碍患病率及危险因素系统评价

doi:10.11852/zgetbjzz2022-1258

摘要/Abstract

摘要： 目的系统评价中国儿童抽动障碍(TD)患病率及致病危险因素,为早期研究提供相关数据。方法检索CNKI、VIP、CBM、WanFang Data、PubMed、Embase和Web of Science数据库中从建库至2022年10月期间所有相关的观察性研究资料,由2位评价员独立筛选文献、提取资料并评价纳入研究的偏倚风险后,采用R语言进行Meta分析。结果共纳入45篇文献,总计271 172名儿童,TD患儿10 594人,我国儿童TD的总患病率为2.68%(95%CI:1.47%~4.83%),Meta回归显示诊断标准为主要异质性来源,以DSM-Ⅳ为诊断标准的TD的总患病率为1.22%(95%CI:0.79%~1.86%),男童总患病率为1.67%(95%CI:0.91%~3.04%),女童总患病率为1.21%(95%CI:0.83%~1.78%)。TD致病的危险因素包括早产、异常出生体重、新生儿黄疸病史、围生期其他不利因素、不良饮食习惯、长时间看电子产品、高热或高热惊厥史、反复呼吸道感染、鼻病或哮喘、注意力缺陷多动障碍及其他神经系统共患病、睡眠障碍、抽动障碍家族史、家族精神性疾病史、母亲孕期精神或情绪异常、家教严厉或打骂体罚的教育方式、家教溺爱、单亲家庭或留守儿童或家庭不和睦、任性发脾气/性格敏感、压力大。结论我国抽动障碍患病率与全球数据接近,男童较女童患病率高,发病与围生期不利因素、慢性呼吸系统疾病、家庭环境等密切相关。

关键词: 抽动障碍, 患病率, 危险因素, Meta分析

Abstract: Objective To systematically retrieved the relevant data and analyze the prevalence and risk factors of tic disorders (TD) in China,in order to provide data reference for further study of TD. Methods A literature search of the CNKI, VIP, SinoMed, WanFang Data, PubMed, Embase and Web of Science databases for relevant observational studies, published from database inception to October 2022, was performed. Literature screening, data extraction and evaluation of risk of bias were independently conducted by two researchers. Data analysis was performed using R software. Results Forty-five studies, including 271 172 children and 10 594 TD children, were included in the Meta-analysis. The overall pooled prevalence of TD in China was 2.68% (95%CI:1.47% - 4.83%). Meta-regression analysis revealed that diagnostic criteria were the main source of study heterogeneity. The pooled prevalence of the TD subgroup, defined according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-Ⅳ), was 1.22% (95%CI:0.79% - 1.86%) and its prevalence in males and females was 1.67% (95%CI:0.91% - 3.04%) and 1.21% (95%CI:0.83% - 1.78%), respectively. Factors associated with TD included preterm birth, abnormal birth weight, neonatal jaundice, other perinatal factors, poor dietary habits, excessive use of electronic devices, history of high fever or febrile convulsions, recurrent respiratory infection, rhinopathy or asthma, attention-deficit hyperactivity disorder or other neurological comorbidities, sleep disorder, family history, psychiatric abnormality during pregnancy, corporal punishment, spoil, single-parent families, emotional lability, and high stress levels. Conclusions The prevalence of TD in China is similar to that in other countries, and males are more prevalent than females. The occurrence of TD is closely related to perinatal factors, chronic respiratory disease, and family stability.

Key words: tic disorders, prevalence rate, risk factor, Meta-analysis

中图分类号:

R749.94

姜妍琳, 张蔷, 翟睿, 彭雅琪, 太然, 王俊宏. 中国儿童抽动障碍患病率及危险因素系统评价[J]. 中国儿童保健杂志, 2023, 31(6): 661-667.

JIANG Yanlin, ZHANG Qiang, ZHAI Rui, PENG Yaqi, TAI Ran, WANG Junhong. Systematic review of the prevalence and risk factors of tic disorders in Chinese children[J]. Chinese Journal of Child Health Care, 2023, 31(6): 661-667.

参考文献

[1] Yang C, Zhang L, Zhu P, et al. The prevalence of tic disorders for children in China[J]. Medicine, 2016,95(30):e4354.
[2] Stiede JT, Woods DW. Pediatric prevention:Tic disorders[J]. Pediatric Clinics of North America, 2020,67(3):547-557.
[3] 余益萍, 田永波, 卢玉龙, 等. 贵州黔南地区7～15岁儿童抽动障碍患病现状及危险因素分析[J]. 中国公共卫生, 2018,34(3):346-349.
Yu YP, Tian YB, Lu YL, et al. Prevalence and influence factors of tic disorders among 7 -15 years old children in Qiannan region of Guizhou province[J]. Chin J Public Health, 2018,34(3):346-349.(in Chinese)
[4] 韩丽彤. 儿童青少年抽动障碍的调查研究[J]. 中国临床实用医学, 2010,4(8):249-251.
Han LT. The study of personality about tic disorders in children[J]. China Clin Prac Med,2010,4(8):249-251.(in Chinese)
[5] 胡国华, 姚静婵, 方美君, 等. 金华市6~15岁儿童抽动障碍流行病学调查[J]. 中华现代儿科学杂志, 2005,2(9):783-785.
Hu GH, Yao JC, Fang MJ. Epidemiological analysis of tic disorder of children aged 6~15 years[J]. Journal of Chinese Modern Pediatrics,2005,2(9):783-785.(in Chinese)
[6] 姜志红, 冯志勤. 洛阳市小学生抽动症的流行学调查[J]. 中国心理卫生杂志, 1998,12(3):164.
Jiang ZH, Feng ZQ. Epidemiological investigation of tic disorders in primary school students in Luoyang[J]. Chinese Mental Health Journal, 1998,12(3):164.(in Chinese)
[7] 冷丽梅, 衣明纪, 张柱海, 等. 莱阳市城乡4～16岁儿童抽动障碍现状调查[J]. 社区医学杂志, 2012,10(7):3-6.
Leng LM, Yi MJ, Zhang ZH. Tic disorder in children aged 4-16 years in Laiyang:A cross-sectional study[J]. JCM, 2012,10(7):3-6.(in Chinese)
[8] 刘玲, 江志贵, 李微, 等. 顺德龙江地区小学生抽动障碍流行病学调查及其与微量元素的关系[J]. 中国当代儿科杂志, 2013,15(08):657-660.
Liu L, Jiang ZG, Li W, et al. Epidemiological investigation of tic disorders among pupils in the Shunde Longjiang area,and their relationship to trace elements[J]. Chin J Contemp Pediatr, 2013,15(08):657-660.(in Chinese)
[9] 刘永翼, 郑毅, 韩书文, 等. 北京市大兴区6～16岁中小学生抽动障碍的现况调查[J]. 中华精神科杂志, 2009,42(4):231-234.
Liu YY, Zheng Y, Han SW. Tic disorders in children aged 6-16 years in Daxing district of Beijing:A cross-sectional study[J]. Chin J Psychiatry, 2009,42(4):231-234.(in Chinese)
[10] 孙鹏. 枣庄市儿童抽动症发病情况调查及影响因素分析[J]. 山东医药, 2011,51(43):67-68.
Sun P. Investigation on the incidence of tic disorders in children in Zaozhuang and analysis of its influencing factors[J]. Shandong Medical Journal, 2011,51(43):67-68.(in Chinese)
[11] 郑荣远, 金嵘, 徐惠琴, 等. 温州地区7～16岁中小学生抽动障碍的现况调查[J]. 中华流行病学杂志, 2004,25(9):745-747.
Zheng RY, Jin R, Xu HQ. Study on the prevalence of tic disorders in schoolchildren aged 7-16 years old in Wenzhou[J]. Chin J Epidemiol, 2004,25(9):745-747.(in Chinese)
[12] 朱焱, 王凯, 张纪水, 等. 长沙市一所小学和中学6-15岁学龄儿童抽动障碍现状调查[J]. 中国心理卫生杂志, 2003,17(6):363-366.
Zhu Y, Wang K, Zhang JS. A survey on tic disorder of children aged 6-15 years[J]. Chinese Mental Health Journal, 2003,17(6):363-366.(in Chinese)
[13] 管冰清, 罗学荣, 邓云龙, 等. 湖南省中小学生精神障碍患病率调查[J]. 中国当代儿科杂志, 2010,12(2):123-127.
Guan BQ, Luo XR, Deng YL. Prevalence of psychiatric disorders in primary and middle school students in Hunan Province[J]. Chin J Contemp Pediatr, 2010,12(2):123-127.(in Chinese)
[14] Xiaoli Y, Chao J, Wen P, et al. Prevalence of psychiatric disorders among children and adolescents in northeast China[J]. PLoS One, 2014,9(10):e111223.
[15] Qu Y, Jiang H, Zhang N, et al. Prevalence of mental disorders in 6-16-year-old students in Sichuan Province, China[J]. Int J Environ Res Pub Health, 2015,12(5):5090-5107.
[16] Yan JJ, Deng H, Wang YM, et al. The prevalence and comorbidity of tic disorders and obsessive-compulsive disorder in Chinese school students aged 6-16:A national survey[J]. Brain Sci, 2022,12(5):650.
[17] Shen Y, Chan BSM, Liu J, et al. The prevalence of psychiatric disorders among students aged 6~16 years old in central Hunan, China[J]. BMC Psychiatry, 2018,18(1):243.
[18] 金嵘, 郑荣远, 黄文武, 等. 浙江省温州地区7～16岁人群Tourette综合征患病率调查[J]. 中华流行病学杂志, 2004,25(2):44-46.
Jin R, Zheng RY, Huang WW. Study on the prevalence of Tourette syndrome in children and juveniles aged 7-16 years in Wenzhou area[J]. Chin J Epidemiol, 2004,25(2):44-46.(in Chinese)
[19] 苏惠琳, 廖琦, 蒋峰, 等. 湖州地区学龄儿童中Tourette综合征流行病学调查[J]. 中国临床神经科学, 2002,10(2):152-154.
Su HL, Liao Q, Jiang F. Investigation of tourette syndrome epidemiology among primary school children in Huzhou area[J]. Chin J clin neurosci, 2002,10(2):152-154.(in Chinese)
[20] 高庆云, 杨正泉, 韩玉芝, 等. 儿童抽动——秽语综合征发病情况调查[J]. 临床儿科杂志, 1984,2(6):357-359.
Gao QY, Yang ZQ, Han YZ. Investigation on the incidence of Tourette's syndrome in children[J]. Journal of Clinical Pediatrics, 1984,2(6):357-359.(in Chinese)
[21] Wong C K, Lau J T. Psychiatric morbidity in a Chinese primary school in Hong Kong[J].Australian and New Zealand Journal of Psychiatry, 1992,26(3):459-466.
[22] 陈秀梅, 郭敏玲, 杨丽新, 等. 多发性抽动症发病相关因素的调查研究[J]. 中国中西医结合儿科学, 2011,3(5):385-387.
Chen XM, Guo ML, Yang LX. Investigation on the related factors of multiple tics[J]. Chin Pediatr Integr Tradit West Med, 2011,3(5):385-387.(in Chinese)
[23] 陈怡, 夏琍群, 马碧涛, 等. 某医院儿童抽动障碍发病因素调查分析[J]. 现代生物医学进展, 2016,16(20):3949-3952.
Chen Y, Xia LQ, Ma BT. Analysis of morbidity factors in child Tic disorders[J]. Progress in Modern Biomedicine, 2016,16(20):3949-3952.(in Chinese)
[24] 高翠琴. 链球菌感染及家庭因素与小儿抽动障碍的关系[J]. 广西医学, 2017,39(5):615-617.
Gao CQ. Relationship of streptococcal infection and family factors with tic disorder among children[J]. Guangxi Medical Journal, 2017,39(5):615-617.(in Chinese)
[25] 龚敏, 胡建邦, 张剑英, 等. 儿童多发性抽动症的环境心理因素分析[J]. 中国公共卫生管理, 2020,36(1):59-62.
Gong M, Hu JB, Zhang JY. Analysis of environmental psychological factors in children with multiple tics[J]. Chin J of PHM, 2020,36(1):59-62.(in Chinese)
[26] 郝娟娟, 吴敏, 朱鹏程, 等. 基于“外象内感”理论的抽动障碍中医病因及围产期危险因素[J]. 教育生物学杂志, 2019,7(1):6-9.
Hao JJ, Wu M, Zhu PC. Analysis of traditional Chinese medicine causes of tic disorders and its perinatal risk factors based on theory of "Waixiang Neigan"[J]. Journal of Bio-education, 2019,7(1):6-9.(in Chinese)
[27] 黄天然, 陆燕珍, 岑丽婷, 等. 肇庆市100例儿童抽动障碍发病危险因素分析[J]. 中外医学研究, 2021,19(6):172-174.
Huang TR, Lu YZ, Cen LT. Analysis on risk factors of 100 children with Tic disorders in Zhaoging City[J]. Chinese and Foreign Medical Research, 2021,19(6):172-174.(in Chinese)
[28] 黄晓玲, 刘长云, Zhangyun L. 儿童抽动障碍Logistic相关因素分析[J]. 中华妇幼临床医学杂志(电子版), 2011,7(6):537-539.
Huang XL, Liu CY. Logistic Regression Analysis of Related Factors on Children With Tic Disorders[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2011,7(6):537-539.(in Chinese)
[29] 季金萍. T细胞免疫及相关心理社会因素与儿童抽动障碍关系的研究[D]. 大连:大连医科大学, 2011.
Ji JP. Correlation Study on T cell immunity, related psychosocial factor and TD[D]. Dalian:Dalian Medical University, 2011.(in Chinese)
[30] 姜俊爽. 儿童抽动障碍相关因素Logistic回归分析及针药并举的临床疗效评价[D]. 沈阳:辽宁中医药大学, 2020.
Jiang JS. Logistic regression analysis of factors related to tic disorders in children and evaluation of clinical efficacy of combination of acupuncture and medicine[D]. Shenyang:Liaoning University of Traditional Chinese Medicine, 2020.(in Chinese)
[31] 蒋颍. 儿童抽动障碍发病危险因素问卷调查分析[D]. 南充:川北医学院, 2020.
Jiang Y. Questionnaire analysis of risk factors for children with tic disorder[D]. Nanchong:North Sichuan Medical College, 2020.
[32] 李丹, 李宜瑞, 何玲云, 等. 儿童抽动秽语综合征相关危险因素分析[J]. 广东医学, 2010,31(20):2698-2699.
Li D, Li YR, He LY. Analysis of risk factors associated with Tourette's syndrome in children[J]. Guangdong Medical Journal, 2010,31(20):2698-2699.(in Chinese)
[33] 李俭俭. 儿童抽动障碍的logistic相关因素分析及疗效观察[D]. 张家口:河北北方学院, 2018.
Li JJ. Logistic Regression Analysis of Related Factors on Children With Tic Disorders and Clinical Observation[D]. Zhangjiakou:Hebei North University, 2018.(in Chinese)
[34] 李树华, 庞保东, 徐应军, 等. 抽动-秽语综合征危险因素的病例对照研究[J]. 中国儿童保健杂志, 2004,12(5):412-414.
Li SH, Pang BD, Xu YJ. Case-control study of risk factors in tourette syndrome[J]. Chinese Journal of Child Health Care, 2004,12(5):412-414.(in Chinese)
[35] 李志飞, 汤晶晶, 邹英杰, 等. 儿童抽动症相关因素的研究[J]. 中国妇幼健康研究, 2016,27(1):20-22.
Li ZF, Tang JJ, Zou YJ. Study on related factors of tourette syndrome[J]. Chinese Journal of Woman and Child Health Research, 2016,27(1):20-22.(in Chinese)
[36] 林宁安, 朱哲, 应勤滨, 等. 影响儿童发生抽动障碍的相关危险因素调查[J]. 中国妇幼保健, 2022,37(11):2058-2060.
Lin NA, Zhu Z, Ying QB. A survey of risk factors related to tic disorders in children[J]. Maternal and Child Health Care of China, 2022,37(11):2058-2060.(in Chinese)
[37] 刘永翼, 郑毅, 韩书文, 等. 北京市大兴区学龄儿童抽动障碍相关危险因素的病例对照研究[J]. 中国心理卫生杂志, 2010,24(1):47-50.
Liu YY, Zheng Y, Han SW. Related factors of tic disorders among schoolchildren in Daxing district of Beijing:A cose-control study[J]. Chinese Mental Health Journal, 2010,24(1):47-50.(in Chinese)
[38] 申海龙. 多发性抽动症相关发病因素及中医体质的探讨[D]. 济南:山东中医药大学, 2017.
Shen HL. Tourette syndrome related related risk factors and constitution of traditional chinese medicine[D]. Jinan:Shandong University of Traditional Chinese Medicine, 2017.(in Chinese)
[39] 孙中运, 衣明纪, 冉霓, 等. Tourette综合征发病危险因素的病例对照研究[J]. 临床儿科杂志, 2011,29(12):1162-1166.
Sun ZY, Yi MJ, Ran N. Risk factors of Tourette syndrome:A case-control study[J]. J Clin Pediatr, 2011,29(12):1162-1166.(in Chinese)
[40] 王宇奇, 王艺潼, 薛承宇, 等. 儿童抽动秽语综合征发病影响因素探讨[J]. 名医, 2020,1(8):82-83.
Wang YQ, Wang YT, Xue CY. Study on the influencing factors of Tourette's syndrome in children[J]. Renowned Doctor, 2020,1(8):82-83.(in Chinese)
[41] 吴敏, 纪小艺. 儿童抽动障碍发病危险因素的病例对照研究[C]. 中华中医药学会儿科分会第三十一次学术大会.昆明, 2014.
[42] 肖光华. 儿童抽动障碍发病因素及中医证候特点研究[D]. 上海:上海交通大学, 2009.
Xiao GH. The Research on Risk Factors and Characteristics of TCM Syndrome to Children's tic disorders[D]. Shanghai:Shanghai Jiao Tong University, 2009.(in Chinese)
[43] 徐逸珩. 基于文献和临床调查探讨小儿抽动障碍中医辨证论治及相关影响因素分析[D]. 上海:上海中医药大学, 2019.
Xu YH. Analysis of TCM syndrome differentiation and treatment of children Tic disorder and related influencing factors based on literature and clinical investigation[D]. Shanghai:Shanghai University of Traditional Chinese Medicine, 2019.(in Chinese)
[44] 杨春松, 张伶俐, 俞丹, 等. 孕期危险因素与儿童抽动障碍关系的配对病例对照研究[J]. 国际精神病学杂志, 2018,45(5):867-870.
Yang CS, Zhang LL, Yu D. Relationships between prenatal risk factors and tic disorders a matched case control study[J]. Journal of International Psychiatry, 2018,45(5):867-870.(in Chinese)
[45] 姚永新, 王年美, 邢晓华, 等. 小儿多发性抽动症临床特征及发病因素调查[J]. 中国妇幼保健, 2019,34(23):5511-5513.
Yao YX, Wang NM, Xing XH. Investigation on clinical characteristics and pathogenic factors of Multiple Tics in children[J]. Maternal and Child Health Care of China, 2019,34(23):5511-5513.(in Chinese)
[46] 赵静. 儿童多发性抽动症相关因素及中医体质分析[D]. 沈阳:辽宁中医药大学, 2013.
Zhao J. Correlative factors of tourette's syndrome in children and analysis of TCM constitution[D]. Shenyang:Liaoning University of Traditional Chinese Medicine, 2013.(in Chinese)
[47] 赵荣香, 罗尧竞, 任丹, 等. 儿童多发性抽动症发病危险因素分析[J]. 中华妇幼临床医学杂志(电子版), 2017,13(2):177-182.
Zhao RX, Luo YJ, Ren D. Analysis of risk factors of children with Tourette syndrome[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2017,13(2):177-182.(in Chinese)
[48] Chen L, Chen X, Ke N, et al. Association between allergic conjunctivitis and provisional tic disorder in children[J]. Int Ophthalmol, 2020,40(1):247-253.
[49] 胡瑞. 对6-13岁在校生563例抽动症的调查报告[J]. 中华现代临床医学杂志, 2003,1(11):1042.
Hu R. An investigation report on 563 cases of tic disorders in school students aged 6-13[J]. Chinese Journal of Current Clinical Medicine, 2003,1(11):1042.(in Chinese)
[50] Scahill L, Specht M, Page C. The prevalence of Tic disorders and clinical characteristics in children[J]. J Obsess-compuls Rel, 2014,3(4):394-400.
[51] Knight T, Steeves T, Day L, et al. Prevalence of tic disorders:A systematic review and meta-analysis[J]. Pediat Neurol, 2012,47(2):77-90.