Clinical Research On Children With Tic Disorders Related To Allergic Rhinitis Based On The Theory Of "Prevention Before Disease Onset" In Traditional Chinese Medicine

Objective1.To explore the risk factors of allergic reaction in children with tic disorders by Meta-analysis.2.To observe the relationship between tic disorders related to allergic rhinitis and pure tic disorders of children in clinical characteristics,the severity of TD,and the symptoms of Chinese medicine.3.To observe the clinical efficacy of Jianpi Zhijing Decoction plus Qiang Huo,Chuan Xiong,and Fangfeng in the treatment of tic disorders related to allergic rhinitis in children with spleen deficiency and liver hyperactivity syndrome based on the theory of"prevention before disease onset".Methods1.CNKI,VIp,Wanfang Data,pub Med,and Embase were searched by computer to collect the pieces of literature about the risk factors of allergy in tic disorder.Based on the including and excluding criteria,screening the literature,extracting data,evaluating the quality of literature with NOS,Meta-analyzing data with Rev Man 5.3.2.Children aged 3～14 with tic disorder and a history of allergic rhinitis were selected by a cross-sectional study based on the including and excluding criteria,the children without a history of allergic rhinitis were compared with who have,and the results of YGTSS,CGI,and Chinese Medicine Syndrome Questionnaire of Tic Disorder were analyzed.3.Using the method of prospective contemporaneous control,we selected 3～14 years old tic disorders children with spleen deficiency and liver hyperactivity syndrome who have a history of allergic rhinitis.Based on the including and excluding criteria strictly,the observation group was given Jianpi Zhijing decoction plus Qiang Huo,Chuan Xiong,and Fang Feng for 8weeks,while the control group was only given Jianpi Zhijing decoction for 8 weeks,the clinical indexes of the two groups were assessed with YGTSS,TCM syndrome classification scale before treatment and in the 4^th week,6^th week,8^th week;CGI was assessed in the 8^th week.After the treatment,it was followed for 8 weeks,the number of cases that were aggravated due to AR was observed,and the severity of TD was determined by YGTSS.Results1.Meta-analysis:a total of 11 articles were included to screen four risk factors of tic disorders:allergic rhinitis,allergic conjunctivitis,asthma and allergic dermatitis.Meta-analysis showed that allergic rhinitis included 7 studies,OR=2.85,95%CI[2.62,3.09],p＜0.00001;allergic conjunctivitis included 4 studies,OR=4.12,95%CI[2.29,7.40],p＜0.00001;Asthma was included in 5 studies,OR=2.41,95%CI[2.18,2.68],p＜0.00001;allergic dermatitis was included in 3 studies,OR=1.83,95%CI[1.43,2.35],p＜0.00001.2.Observational study:a total of 254 cases,including a history of allergic rhinitis in 135children with tic disorders,accounting for 53.1%（1）In terms of gender,age of onset,type of tic,and course of the disease,there was no significant discrepancy between TD children with a history of allergic rhinitis and those with pure TD（p>0.05）;After excluding TTD children,the discrepancy still have no statistical significance（p>0.05）.（2）At the incidence of nasal tissue as the first picked portion,the TD child with a history of allergic rhinitis is higher than those of pure TD children,and the discrepancy has statistical significance（p＜0.05）;（3）In the sigh or gas atmospheric plow,the incidence of TD in children with allergic rhinitis is lower than the incidence of children with simple TD（p＜0.05）;in blinking or squeezing/glare,eyebrows,Nose moving,mouth,head,neck move,shrug hand/arm,abdomen,leg or foot/toe,body movement,cough,throat,snoring,squat,repeating words,screaming,there were no statistical significance in the discrepancy between the two groups（p>0.05）;（4）In the YGTSS score,the tertiary,the CGI score,the TD child in the history of allergic rhinitis is higher than those of simple TD children,and the discrepancies have statistical significance（p＜0.05）;After excluding TTD children,there was no significant discrepancy in the severity of children in the two groups,and the CGI score either（p>0.05）;（5）In the distribution of TCM syndromes,the proportion of spleen deficiency and liver-hyperactivity syndrome in TD patients with a history of allergic rhinitis was the highest,and the proportion of liver-hyperactivity and wind-motion syndrome in TD patients alone was the highest.the two groups have statistically significant discrepancies（p＜0.05）;After excludingTTD children,The percentage of the syndrome of spleen deficiency and liver hyperactivity in TD patients with a history of allergic rhinitis was the highest,and the percentage of the syndrome of phlegm-fire disturbing the spirit in TD patients was the highest.The two groups have statistically significant discrepancies（p＜0.05）.3.Interventional study:Two groups ultimately included 20 patients,two groups have comparability in gender,age,the severity of TD（p>0.05）.（1）After treatment,the observation group and the control group have no significant discrepancy in total curative effect and TCM syndrome curative effect（p>0.05）,after excluding TTD,the result is the same.（2）In the total score of YGTSS,the time effect in the two groups were statistically significant（p＜0.05）,and the discrepancy between the two groups was statistically significant（p＜0.05）,it was suggested that the scores of both groups were decreased;the interaction was not statistically significant（p>0.05）,and the intergroup effect was not statistically significant（p>0.05）;There was no significant discrepancy between the Observation group and the control group in 4^th week（p>0.05）,but there was a significant discrepancy in 6^th and 8^th week（p＜0.05）,and the score of the observation Group was under compared to the control group;after excluding TTD,there was the interaction between two groups（p＜0.05）,and the decrease of observation group was more obvious.（3）In the total score of TCM syndrome,the time effect in the two groups were statistically significant（p＜0.05）,and the discrepancy between the two groups was statistically significant（p＜0.05）,it was suggested that the scores of both groups were decreased;the interaction was not statistically significant（p>0.05）,and the intergroup effect was not statistically significant（p>0.05）;There was no significant discrepancy between the two groups in 4^th,6^th and 8^th week（p>0.05）;after excluding TTD,the discrepancy of 4^th week between the two groups was statistically significant（p＜0.05）,and the Observation Group score was lower than the control group.（4）During the treatment cycle,there were no significant adverse reactions from children in the two groups.（5）After 8 weeks of follow-up,there was no significant discrepancy between the observation group and the control group in the number of repeated or aggravated tic disorders caused by the attack of allergic rhinitis（p>0.05）.Conclusions1.Meta-analysis showed that allergic rhinitis,allergic conjunctivitis,asthma,and allergic dermatitis were the allergic risk factors of tic disorders in children;2.Observing studies have shown that more than half of children with cataracts have allergic rhinitis disease;allergic rhinitis does not affect the gender,pathogenesis,pathogenesis of TD,but can increase the severity of overall TD;The first tissue symptoms of TD children are dominated by facial,and the nasal curative incidence of TD patients with a history of allergic rhinitis is higher;TD children with a history of allergic rhinitis disease,Chinese medicine syndrome is the spleen deficiency lord,simple TD children are mainly motivated by hepatorism,and simple CTD and TS children are dominated by phlegm.3.According to the theory of"prevention before disease onset",it is effective and advantageous to use Jianpi Zhijing Decoction plus Qianghuo,Chuanxiong,and Fangfeng to treat spleen deficiency and liver hyperactivity syndrome in children with tic disorders associated with allergic rhinitis,it is safe to treat tic disorders with traditional Chinese medicine.