摘要目的 探讨视听整合持续操作测试(IVA-CPT)在Tourette综合征(TS)共患注意缺陷多动障碍(ADHD)中的应用价值.方法 采用美国精神疾病诊断与统计手册第4版(DSM-Ⅳ)及IVA-CPT对519例临床拟诊TS共患ADHD患儿(设为观察组)进行诊断评估和测试;收集同期临床拟诊ADHD患儿857例(设为对照组)进行同样量表评估及测试.将DSM-Ⅳ诊断作为金标准,对IVA-CPT结果进行分析.结果 1.IVA-CPT应用于诊断TS患儿是否共患ADHD时灵敏度为62.4％、特异度为81.9％,符合率为75.7％.2.IVA-CPT应用于诊断TS患儿是否共患ADHD时漏诊例数62例,其中注意缺陷型、多动冲动型、混合型漏诊率分别为30.3％(10/33例)、51.4％(37/72例)、25.0％(15/60例),多动冲动型的漏诊率高于注意缺陷型和混合型,差异有统计学意义(x2=10.646,P＜0.05).3.观察组与对照组2种诊断方法均为阳性共449例,其中观察组103例,对照组346例.观察组和对照组综合商数、视觉商数、听觉商数分别为89.0±19.5/77.4±18.2、92.4±19.0/84.3±18.9、89.6±16.8/77.4±19.7,差异均有统计学意义(t=-5.024、-3.533、-5.255,P均＜0.05);在综合反应控制、视觉反应控制、综合注意力、视觉注意力方面,观察组与对照组比较差异有统计学意义(t=-2.510、-2.836、-1.402、-2.501,P均＜0.05).结论 1.IVA-CPT是辅助诊断TS患儿是否共患ADHD有效的客观检查工具,对鉴别TS共患ADHD时的抽动与多动症状诊断价值较高.2.TS共患ADHD患儿以注意功能损害为主,整体说来TS共患ADHD患儿的注意及控制功能损害要轻于单纯ADHD患儿.

abstractsObjective To explore the value of the integrated visual and audio continuous performance test (IVA-CPT) in the diagnosis of Tourette syndrome(TS) patients who have comorbid attention deficit hyperactivity disorder(ADHD).Methods IVA-CPT was performed in 519 TS patients with comorbid ADHD (observation group)and 857 patients with pure ADHD (control group).The "gold standard" for the diagnosis of ADHD was based on the Diagnostic and Statistical Manual of Mental Disorders (4th version,USA) (DSM-Ⅳ).Results (1) When DSM-Ⅳ was used as the "gold standard",the sensitivity,specificity and coincidence rate of IVA-CPT were 62.4％,81.9％ and 75.7％,respectively.(2) IVA-CPT misdiagnosed 62 cases in TS + ADHD group,including 30.3％ (10/33 cases) inattentive subtype (ADHD-I),51.4％ (37/72 cases) hyperactive subtype (ADHD-H) and 25.0％ (15/60 cases) combined subtype (ADHD-C).Significant difference in misdiagnosis rate was found among ADHD-H and ADHD-I and ADHD-C (x2=10.646,P＜0.05).(3) There were 449 cases in which 2 diagnostic methods were both positive in both observation group and control group,including 103 cases in observation group and 346 cases in control group.The full scale response control quotient,visual reaction control,auditory reaction control in observation group and control group were 89.0±19.5/77.4±18.2,92.4±19.0/84.3±18.9,89.6±16.8/77.4±19.7,and there were significant differences between 2 groups (t=-5.024,-3.533,-5.255,all P＜0.05).The full scale response control quotient,visual response control quotient,full scale attention quotient and visual attention quotient between the 2 groups were statistically significant (t=2.510,-2.836,-1.402,-2.501,all P＜0.05).Conclusions (1) IVA-CPT can be used as an effective and objective tool for the diagnosis of TS children with comorbid ADHD.(2)Comparcd with TS childrcn with comorbid ADHD,pure ADHD children have a higher attention and control impairment.