【作者】 乔阳；

【导师】 都萍；

【作者基本信息】 山西医科大学 ， 儿科学， 2004， 硕士

【摘要】 目的：抽动障碍（ｔｉｃ　ｄｉｓｏｒｄｅｒｓ）是起病于儿童和青少年时期，具有明显遗传倾向的精神、行为障碍，它是一种多因素共同作用导致的疾病，在治疗过程中容易反复，因此，本课题就抽动障碍儿童细胞免疫功能的变化、抗核抗体的产生、儿童心理个性、母亲孕产期情况、父母教育方法以及家庭情况进行了研究，进一步探讨抽动障碍的病因及发病机制，为临床提供相应的治疗对策。　　　　　方法：本研究采用病例对照的实验方法，对 ３０ 例抽动障碍儿童和 ３０例正常儿童实施了血液抗核抗体、Ｔ 淋巴细胞亚群总 Ｔ 淋巴细胞百分率（ＣＤ３）、辅助 Ｔ 淋巴细胞百分率（ＣＤ４）、抑制性 Ｔ 淋巴细胞百分率（ＣＤ８）和 ＣＤ４／ＣＤ８ 比值的实验室检查，以及家庭情况调查问卷、艾森克个性问卷（儿童）、父母亲养育方式量表调查，资料使用 ＳＰＳＳ１１．０ 软件进行 ｔ－检验、χ２检验、Ｓｐｅａｒｍａｎ等级相关分析以及ＳＡＳ８．０软件进行Ｌｏｇｉｓｔｉｃ回归分析。　　　　　　结果：病例组 ＣＤ３、ＣＤ４、ＣＤ４／ＣＤ８ 比值显著低于对照组，病例组抗核抗体（ＡＮＡ）吸光度值显著高于对照组。家庭情况调查问卷显示遗传因素、父母婚姻状况、孕期情绪不良、出生窒息、孕期接触有毒物体、患儿精神过度紧张等 ９ 个因素，病例组与对照组有显著性差异。父母养育方式量表结果显示：　病例组父母“情感温暖、理解”得分显著低于对照组，而病例组父母“惩罚、严厉”　、“拒绝、否认”　、“过分干涉”因子得分明显高于对照组。艾森克个性问卷（儿童）结果显示病例组 ＥＰＱ 得分在 Ｐ（精神质）、Ｎ（神经质）上显著高于对照组，在 Ｌ（掩饰性）效度得分显著低于对照组。对上述统计检验有显著性差异的资料进行单因素 Ｌｏｇｉｓｔｉｃ 回归分析，结果显示 ＥＰＱ－Ｐ，ＥＰＱ－Ｌ、ＥＰＱ－Ｎ，父“温暖理解”、父“拒绝”、父“干涉”、母“拒绝”、母“干涉”、母“温暖理解”、ＣＤ４ 等 １０ 个因素有显著性差异，在单因素分析的基础上，　将分析中有显著意义的变量共 １０ 个引入回归方程，在ＳＡＳ８．０ 统计软件包上进行逐步非条件 Ｌｏｇｉｓｔｉｃ 回归分析，结果父亲“拒绝因子”及母亲“拒绝因子”为显著危险因素。　 结论：抽动障碍儿童存在细胞免疫功能紊乱，即细胞免疫功能降低以及病毒或细菌感染后自身抗体（抗核抗体）的产生。母亲孕期情绪不良、 II<WP=5>孕期接触有害物质、患儿出生窒息、患儿长期精神紧张、发病前诱发因素（如遭受打骂）、学习负担过重、患儿个性偏于神经质和精神质以及父母亲的不良教育方式都可能是儿童发生抽动障碍的危险因素，其中父母亲对患儿过多的拒绝和否定为显著危险因素。更多还原

【Abstract】 Objective：Tic disorders is a kind of neural and mental disease with evidenthereditary tendency. It has been found in some adolescents. Because we haveknown many factors can lead to tic disorders ，the study aimed at investigatingdeeply its　cellular immune function 、anti-ANA（antinuclear antibody）、personality、 mother＇ｓ　　pregnancy 、parental rearing patterns and familysurroundings ，exploring profoundly its etiology mechanism and providingappropriate measures of clinical intervention.Method：The paper adopted case control experimental method.The 30 childrenwith TD and 30 normal children were implemented laboratory check aboutantinuclear antibody（ANA）、T lymphocyte subsets such as total T lymphocytepercent CD3、helper T cell percent CD4、suppressor T cell percent CD8 andhelp/suppressor radio（CD4/CD8）in blood and questionnaire about tic disordersfamily status，EPQ （children）and Egna Minnen av Barndoms Uppfostran（EMBU）.The data was handled and analysed with SPSS11.0 and SAS8.0statistical soft system.Results: The CD3、CD4 and helper/suppressor ratio （CD4/CD8）weresignificantly lower in case group than in control group, the absorbency ofanti-ANA were significantly higher in case group than in control group.Family status questionnaire indicated that there were 9 factors which hadsignificant difference between the case group and the control group .The 9factors were heredity、parental marriage status、bad mood during the pregnancy、asphyxia of newborn、poisonous matter 、children＇ｓ　over-tension in mentalstate、catching a cold recently、inducing factors and the heavy study burden oneby one. EMBU showed： the factor“affect warmth”scores for the father andmother scale of EMBU in case group were significantly lower than those of IV<WP=7>control group. The scores on factors such as “punishment” 、“refusal” 、“interference ”of father and mother scale of EMBU in case group were foundsignificantly higher than those of the control group. EPQ showed：the scores ofP、N were significantly higher in case group than in control group. The scores ofL were significantly lower in case group than in control group. Single factorlogistic regression analysis indicated that the following factors EPQ-P、EPQ-L、ＥＰＱ－Ｎ、“punishment”，“refusal”“interference ”“affect warmth”of parents scale of EMBU and CD4 had significant difference. Logisticstepwise regression analysis indicated that“refusal”of father and mother scaleof EMBU were the most risky factors.　　Conclusion：Children with tic disorders had the abnormity of cellular immunefunction and the higher concentration of autoantibody being broughtout after the patients were affected by the virus and bacteria. Heredity、parental marriage status、bad mood during pregnancy、asphyxia of newborn、poisonous matter 、children＇over-tension in mental state、catching a coldrecently、inducing factors 、the heavy study burden 、the personality ofneurotic character 、psychic character and the parental bad rearing patternswould be the risky factors which resulted in tic disorders. Among thesefactors “refusal”of father and mother scale of EMBU were the most riskyfactors.更多还原