發(fā)布時間：2018-03-10 12:52

  本文選題：抽動障礙　切入點(diǎn)：血清總IgE　出處：《北京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

【摘要】：目的:抽動障礙(tic disorders,TD),是一種在兒童期發(fā)病、慢性的精神心理疾病,目前本病的病因病機(jī)尚不明確,臨床診斷缺乏特異性指標(biāo),治療方面也缺乏相關(guān)統(tǒng)一明確的方案。在免疫相關(guān)的研究中還缺乏統(tǒng)一性,需要進(jìn)一步的研究。TD患兒中有50.8%的在抽動發(fā)病、反復(fù)或加重前有反復(fù)上呼吸道感染、慢性鼻炎、咽炎等病史,這與血清總IgE介導(dǎo)的Ⅰ型變態(tài)反應(yīng)類似。目前對于血清IgE的研究較少,而且血清IgE與TD的相關(guān)性的結(jié)論也各不相同。因此我們在本次研究中,希望通過測定血清總IgE的水平及其用藥前后的變化來研究TD與過敏反應(yīng)的相關(guān)性,同時也通過靜心止動方治療TD患兒前后的對照研究,探討此方治療TD中可能存在的變態(tài)反應(yīng)的相關(guān)機(jī)理。方法:通過對2015年10月-2016年10月期間前來廣安門醫(yī)院就診的患兒嚴(yán)格按照納排標(biāo)準(zhǔn)入組要求篩選、剔除,在經(jīng)家長患兒同意并簽署知情同意后,分別納入TD組和陽性對照組。TD組經(jīng)過靜心止動方治療3個月,并采用YGTSS評分對其治療前后進(jìn)行病情嚴(yán)重程度評估,同時運(yùn)用減分率評價治療的療效;實(shí)驗室指標(biāo)通過測定TD組治療前、后與陽性對照組進(jìn)行比較分析。結(jié)果:本次研究TD組一共納入142例,其中男性115人,女性27人,男女比例4.26:1,年齡最小3歲,最大15歲,平均年齡(8.04±2.69)歲。TD患兒經(jīng)治療后根據(jù)減分率結(jié)果顯示:顯效46例(32.39%),有效63例(44.37%),效果不明顯33例(23.24%),總有效109例(76.76%)。TD患兒的血清總IgE總陽性率為35.21%,TD患兒的血清總IgE水平與陽性對照組相比差異較大。治療后的TD患兒血清總IgE水平較治療前略有降低,具有顯著差異,其中男性患兒治療前后血清總IgE水平變化具有顯著差異。TD的嚴(yán)重程度與血清總IgE的水平無關(guān)。實(shí)驗組春季、夏季、秋季血清總IgE水平均有顯著差異,對照組無明顯差異。本次入組TD患兒治療前后部分患兒尿常規(guī)輕微異常,肝腎功能均未見異常。結(jié)論:(1)靜心止動方治療TD的療效顯著。(2)不能完全否定TD與過敏反應(yīng)的相關(guān)性。(3)TD可能與血清總IgE水平的變化相關(guān)。(4)TD的嚴(yán)重程度與血清總IgE的水平不具有相關(guān)性。(5)TD患兒的血清總IgE水平變化可能受季節(jié)影響。
[Abstract]:Objective: TDs is a chronic mental and psychological disorder in childhood. At present, the etiology and pathogenesis of TDs are not clear, and the clinical diagnosis is lack of specific indexes. There is also a lack of unified and definite treatment programs. In immune-related studies, there is still a lack of uniformity. 50.8% of children with TD need further study. 50.8% of children with TD have recurrent upper respiratory tract infections, chronic rhinitis before recurrence or aggravation. The history of pharyngitis is similar to the type I allergy mediated by total serum IgE. There are few studies on serum IgE and different conclusions on the correlation between serum IgE and TD. We hope to study the correlation between TD and allergic reaction by measuring the level of serum total IgE and the changes before and after treatment. At the same time, we also hope to study the control study before and after the treatment of children with TD by Jing Xin Zhi Fang. To explore the mechanism of this prescription in the treatment of possible allergy in TD. Methods: by screening and eliminating the children who came to Guanganmen Hospital from October 2015 to October 2016 according to the standard of Nanodrainage strictly. After the parents agreed and signed the informed consent, they were included in the TD group and the positive control group. The TD group was treated with Jing Xin Zhi Fang for 3 months, and the severity of the disease was evaluated by YGTSS score before and after treatment. At the same time, the efficacy of the treatment was evaluated by using the score reduction rate, and the laboratory indexes were compared with the positive control group before and after the treatment. Results: 142 cases were included in the TD group, including 115 males and 27 females. The ratio of men to women is 4.26: 1, aged as young as 3 and up to 15, The average age of children was 8.04 鹵2.69 years old. According to the score reduction rate after treatment, the results showed that 46 cases had marked effect (32.39%), 63 cases had significant effect (44.37%), 33 cases had no obvious effect and 33 cases had no significant effect. The total positive rate of serum total IgE in patients with total effective 109 cases was 35.21 T and the total IgE positive rate was 35.21%. The serum total IgE level of children with TD after treatment was slightly lower than that before treatment. There were significant differences in serum total IgE level before and after treatment. The severity of TD was not related to the serum total IgE level. There were significant differences in the serum total IgE levels in the experimental group in spring, summer and autumn. There was no significant difference in the control group. Before and after treatment, some of the children with TD had slight abnormal urine routine. Conclusion the therapeutic effect of Jingxinzhuo recipe on TD is significant. 2) it can not completely deny the correlation between TD and allergic reaction. Td may be related to the change of serum total IgE level. The severity of TCD is related to the total IgE in serum. The level of serum total IgE may be affected by seasons.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.7

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