Study On Clinical Efficacy And Related Factors Of Combination Of Traditional Chinese And Western Medicine In The Treatment Of Tic Disorder In Children

Objective: Through retrospective study,to evaluate the efficacy and of combination of traditional Chinese and western medicine in the treatment of children with tic disorders(TD),and to analyze the relevant factors affecting the efficacy of combination of traditional Chinese and western medicine in the treatment of TD,in order to provide reference for clinical intervention and further improve the clinical efficacy.Methods: 212 children who met the inclusion criteria in the tic disorder clinic of the first affiliated Hospital of Tianjin University of traditional Chinese Medicine were selected for the study.1.Record the sex,age of seeing a doctor,age of onset,course of disease,diagnosis type of western medicine,severity of disease,co-disease,distribution of TCM syndromes,use of western medicine,and analyze the clinical characteristics of children with TD treated with combination of traditional Chinese and western medicine.2.Evaluation of curative effect: the YGTSS scores were recorded before treatment,6 weeks after treatment and 12 weeks after treatment,and the reduction rate of 12 weeks was used as the index to determine the curative effect.3.Factors related to efficacy: using a case-control study,the children were divided into effective group(YGTSS score reduction rate ≥30%)and ineffective group(YGTSS score reduction rate < 30%)according to the 12-week treatment effect.Observe the general conditions of the children(sex,age,only child,health status at birth,fetal birth,family history,past history and surgical trauma),clinical features(age of onset,course of disease,western medical diagnosis,severity,initial symptoms,co-disease,auxiliary examination),TCM syndrome types,family psychological conditions(improper family rearing style,introversion,sensitivity,inferiority,willfulness),The correlation between treatment and curative effect.4.Follow-up: The efficacy and adverse reactions of combination of traditional Chinese and western medicine treatment for 24 weeks were followed up,and the changes of YGTSS score were recorded after 12 weeks.Results:1.Clinical characteristics of children with TD treated by combination of traditional Chinese and western medicine A total of 212 children with TD were included,with a male-to-female ratio of 3.33:1.85.4% of them were 7 years old,53.3% were 7-12 years old,and 70.3% the course of disease were more than 1 year.Western medicine diagnosis was mainly TS(54.3%),followed by TTD63(29.7%),CTD 34 cases(16.0%).The total score of YGTSS was 36.54±10.77.The severity of the disease was moderate in 163cases(76.9%),followed by severe in 25 cases(11.8%),mild in 24 cases(11.3%).There were 51 cases(24.1%)with no common disease.The distribution of TCM syndrome types were 62 cases(29.3%)of hyperactivity of liver wind syndrome,45 cases(21.2%)of phlegm fire disturbing god syndrome,42 cases(19.8%)of qi stagnation and fire-changing syndrome,27cases(12.7%)of spleen deficiency and phlegm accumulation syndrome,26 cases(12.3%)of external wind syndrome and 10 cases(4.7%)of yin deficiency wind movement syndrome.One kind of western medicine was mainly used in149 cases(70.3%),followed by 2 kinds of western medicine in 59 cases(27.8%)and 3 kinds of western medicine in 4 cases(1.9%).2.Evaluation of curative effect of combination of traditional Chinese and western medicine on TD(1)The total effective rate of 212 children with TD was 79.3% in 12-week treatment with combination of traditional Chinese and western medicine.In the 6th and 12 th weeks,the YGTSS total score,motor tic score,vocal tic score and defect rate score were significantly different from those before treatment(P<0.05).There were also significant differences between the 6th week and the 12 th week.(P<0.05).(2)There was no significant difference in the curative effect of different western medicine diagnosis and classification(P > 0.05);There are significant differences in the curative effect among different severity of the disease.(P<0.05),the curative effect of severe children is poor,and the curative effect of mild to moderate children is better3.Related factors affecting the efficacy of combination of traditional Chinese and western medicine in the treatment of TD(1)General condition: there was significant difference in the family history of tic disorder and history of recurrent respiratory tract infection on the curative effect(P<0.05),indicating that there was family history of tic disorder and the curative effect of combination of traditional Chinese and western medicine in children with previous respiratory tract infection was poor.There was no significant difference in sex,age,only child condition,health status at birth,mother’s pregnancy and perinatal period,distribution of delivery period,mode of production,family history of mental disorders,family history of migraine,family history of epilepsy,other past history and surgical trauma history on the curative effect(P>0.05).(2)Disease condition: The effect of combination of traditional Chinese and western medicine on the curative effect of children with more than 3 years course of disease,severe disease and co-ADHD was statistically different(P<0.05),the curative effect of this kind of children is poor.There was no significant difference in the age of onset,the type of western medicine diagnosis,the first symptom,co-occurrence of OCD,AD,EP and abnormal auxiliary examination.(3)Different TCM syndrome types: There were significant differences in the influence of different TCM syndrome types on the curative effect,in which yin deficiency wind movement syndrome and spleen deficiency and phlegm accumulation syndrome have obvious influence on the curative effect(P<0.05),suggesting that the curative effect was not good in children with yin deficiency wind movement syndrome and spleen deficiency phlegm accumulation syndrome.(4)Family psychological factors: There was significant difference in the effect of improper family rearing style on the curative effect(P < 0.05),There was no significant difference in the influence of introversion,sensitivity,inferiority and willfulness on the curative effect(P >0.05).suggesting that the curative effect of combination of traditional Chinese and western medicine was not good.(5)Treatment: There was no significant difference in the curative effect between taking one kind of western medicine and taking two or more kinds of western medicine(P>0.05).(6)Multivariate regression analysis showed that family history of tic disorder(OR5.666,P=0.033),recurrent respiratory tract infection(OR3.095,P=0.019),course of disease over 3 years(OR3.167,P=0.011),co-infection of ADHD(OR2.810,P=0.024),phlegm accumulation syndrome of spleen deficiency(OR5.867,P=0.028),wind movement syndrome of yin deficiency(OR10.534,P=0.019),improper family rearing style(OR2.891,P=0.018)is an independent risk factor affecting the efficacy of TD.4.Follow-up care(1)There was significant difference in effective rate between 24 weeks,12 weeks and 6weeks after treatment with combination of traditional Chinese and western medicine(P <0.05),but there was no significant difference between 24 weeks and 12 weeks(P>0.05).(2)The change of YGTSS score after 12 weeks of follow-up: 20 cases(91.0%)achieved clinical control and obvious effect,followed by effective in 2 cases(9.0%).The YGTSS score after 12 weeks was no significant difference compared with that before withdrawal(P>0.05),it is suggested that the curative effect is stable in the process of stopping western medicine,and there is no recurrence or aggravation of the disease.Conclusion:1.Most of the children with TD treated with combination of traditional Chinese and western medicine in the department of childhood encephalopathy in our hospital were moderate and severe TS,and the syndrome differentiation of traditional Chinese medicine was mostly wind syndrome of liver hyperactivity.2.The combination of traditional Chinese and western medicine in the treatment of TD can significantly improve the clinical symptoms of children,reduce the defect rate,the curative effect is positive,and the adverse reactions are less,safe and reliable.3.Family history of tic disorder,history of recurrent respiratory tract infection, course of disease more than 3 years,co-infection of ADHD,phlegm accumulation syndrome of spleen deficiency,wind movement syndrome of yin deficiency,improper family rearing style are the risk factors affecting the curative efficacy of combination of traditional Chinese and western medicine in the treatment of TD.