Tourette综合征患儿血清睾酮和催乳素的水平及相关性探讨

中图分类号 密级Tourette综合征患儿血清睾酮和催乳素的水平及相关性探讨Correlation study of serum testosterone and prolactin in childrenwith Tourette Symdrome计：学位论文： 41页表 格： 11个插 图： 4幅李静指导教师：陈虹教授申请学位级别：硕士学位 学科(专业)：儿科学培养单位：大连医科大学附属第一医院 完成时间：二O一三年四月答辩委员会主席：独创性声明IIII I LI lU I U I III IIIIL UIY231 1 070本人声明所呈交的学位论文是本人在导师指导下进行的研究工作及取得的研究成果。据我所知，除了文中特别加以标注和致谢的地方外，论文中不包含其他人已经发表或撰写过的研究成果，也不包含为获得大连医科大学或其他教育机构的学位或证书而使用过的材料。与我一同工作的同志对本研究所做的任何贡献均已在论文中作了明确的说明并表示谢意。学位论文作者签名： 墨磐签字日期： 垃年上月日关于学位论文使用授权的说明本学位论文作者完全了解学校有关保留、使用学位论文的规定，同意学校保留并向国家有关部门或机构送交论文的复印件和电子版，允许论文被查阅和借阅。本人授权大连医科大学可以将本学位论文的全部或部分内容编入有关数据库进行检索，可以采用影印、缩印或扫描等复制手段保存和汇编本学位论文。本学位论文属于(请在以下相应方框内打“”)： 1保密口，在解密后适用本授权书。2不保密熙作者签名：导师签名：日期：加房年士月髟日日期：2口吗年岁月够日撕灿目 录一、摘要1(一)中文摘要1(二)英文摘要3二、正文5(一)前言5(一)日|J舌”一”“5(二)材料和方法61研究对象611 Tourette综合征组612对照组62研究方法721评估工具及实验准备722研究步骤823统计学处理9(三)结果91两组儿童年龄性别比较92两组儿童家庭情况比较93两组儿童CBCL行为量表评分比较94两组儿童内分泌激素检测结果比较1041两组睾酮水平比较1 042两组催乳素水平比较一1 15不同抽动程度的TS儿童睾酮、催乳素水平比较1 16是否共患ADHD的TS儿童睾酮、催乳素水平比较oi 0 0 0127TS儿童睾酮、催乳素与年龄、临床及家庭因素的相关分析“”128TS儿童睾酮、催乳素与CBCL行为问题的相关分析13(四)讨论1 4(五)结论2 O(六)参考文献2 1三、综述25(一)综述25(二)参考文献33四、附录38五、致谢41大连医科大学硕士学位论文Tourette综合征患儿血清睾酮和催乳素的水平及相关性探讨硕士生姓名：李静指导教师：陈虹教授专业名称：儿科学摘要目的：检测Tourette综合征(TS)儿童血清睾酮和催乳素水平，初探内分泌因素在TS中的作用；评估分析TS儿童的临床状况及行为特征与上述内分泌激素的关系及可能的病理机制。方法：检测31例TS组儿童和30例正常组儿童的血清睾酮和催乳素水平，两组被试完成一般情况调查问卷及儿童行为量表(CBCL，家长用)。采用耶鲁综合抽动严重程度量表(YGTSS)评估TS儿童的抽动严重程度，同时调查评估TS儿童的病程、是否共患ADHD等临床状况。采用卡方检验、r检验、两独立样本秩和检验比较两组儿童数据，通过f检验、两独立样本秩和检验分析病例组儿童不同临床状况下的血清睾酮和催乳素变化。采用Pearson相关分析、Spearman相关分析对病例组儿童的相关指标进行分析。结果：两组儿童年龄、性别、家庭类型比较，差异无统计学意义(尸005)；两组儿童养育类型、父亲文化程度、母亲文化程度比较，差异有统计学意义(P005)。两组儿童CBCL行为量表评分比较，TS组儿童在退缩、躯体主诉、焦虑抑郁、思维问题、注意问题、攻击行为、内向行为、外向行为及行为总分方面均明显高于正常对照组，差异有统计学意义(尸001)。两组儿童内分泌激素检测结果比较：TS组儿童睾酮水平高于对照组，差异有统计学意义(尸005)。病例组儿童是否共患ADHD的分组比较：TS共患ADHD组催乳素水平高于单纯TS组，差异有统计学意义(尸O05)；TS共患ADHD组睾酮水平与单纯TS组比较，差异不具统计学意义(胗0。05)。病例组儿童睾酮、催乳素与年龄、临床、家庭因素的相关分析：睾酮与年龄正相关(b=O356，P005)，与病程正相关(珞=0555，大连医科大学硕士学位论文P005)。结论：TS儿童的睾酮水平高于正常儿童；且与年龄、病程有关，年龄越大、病程越长，睾酮水平增高越明显。TS儿童的催乳素水平与正常儿童比较未见明显差异，但TS共患ADHD儿童的催乳素水平较单纯TS儿童增高。Ts儿童存在明显且广泛的行为问题，但TS儿童的行为与睾酮、催乳素未见相关性。关键词：睾酮催乳素Tourette综合征儿童2大连医科大学硕士学位论文Correlation study of serum testosterone and prolactin inchildren with Tourette SymdromeMaster degree candidate：Li JingSupervisor：Professor Chen hongMaj or：PediatricsAbstraetObjeetive：Test the levels of testosterone and prolactin of children with Tourettesyndrome(TS)and explore the role of icretion factor in TS；Conduct evaluationanalysis of the relation between the clinical condition and behavior characteristics ofchildren with TS and the abovementioned endocrine hormone，as well as the possiblepathological mechanismMethod：Test the levels of testosterone and prolactin of two groups，the first groupconsists of 3 1 children with TS and the second consists of 3 0 normal childrenTwogroups will go through the general condition questionnaire investigation and ChildrenBehavior Checklist(CBCL)testYale Global Tic Severity Scale(YGTSS)will beadopted to assess the tic severity scale of children with TSMeanwhile，investigate andevaluate the course of disease of children with TS and check if they all have AttentionDeficit Hyperactivity Disorder(ADHD)and other clinical conditionsCompare the databetween two groups through chi=square test，t test and twosample rank-sum test，andanalyze the variations of testosterone and prolactin of the first group under differentclinical conditions through t test and twosample ranksum testAnalyze the index ofcorrelation of the first group by using PearsonS correlation analysis and SpearmanScorrelation analysisResults：The differences of age，gender and family type between two groupshave no stmistical significance(尸005)；while the differences of nurture style，fatherSeducmion level and mother S educmion level between two groups have statisticalsignificanceO05)According to the scores of CBCL between two groups，thegroup witll TS has higher scores in flinch，somatic complaints，anxietydepression，thinking issue，attentions，aggressive behavior，intemalizing behavior，externalizingbehavior and total behavior than the NC(normal contr01)groupThe difference betweentwo groups has statistical significance(P00 1)According to the endocrine hormone大连医科大学硕士学位论文test results of two groups，the group with TS has higher testosterone level than the NCgroupThe difference between two groups has statistical significance伊005)Divide the group with TS into smallgroups based on the tic severity scale and compare：moderately severe tic group(testosterone level)and mild tic group，moderately severe tic group(prolactin level)andmild tic groupThe difference has no statistical significance仔005)Divide thegroup with TS into two small groups，one group has ADHD and the other group has notThe group with ADHD has higher prolactin level than the other groupThe differencebetween two groups has statistical significance005)And the difference oftestosterone level between two small groups has no statistical significance pO05)The analysis on the relation between the levels of testosterone and prolactin of childrenwith TS and age，clinical conditions and family factors：the testosterone level isproportional to age(rs=0：356，P005)，and it is proportional to the course of disease(扩O555，P005)；the rest factors have no correlation胗O05)QThe analysis on therelation between the levels of testosterone and prolactin of children with TS and CBCLtest results：the testosterone and prolactin have no relation、析th each factor of CBCL orthe total scores f胗005)Conclusion：The children with TS have higher testosterone level than nor