| Objective;1 To understand the drug reduction process of Tiapride in detail and explore the advantageous drug reduction programme through reviewing the drug reduction process of Tiapride in TD children who treated with Tiapride plus traditional Chinese medicine(TCM)within 12 weeks.Combined with the therapeutic effect after 12 weeks,this study may provides reference for the design of gradually reducing and stopping Western medicine in the treatment of tic disorders with integrated Chinese and Western medicine.2 To explore the relevant influencing factors of Tiapride reduction through the retrospective investigation which combining survey results of the demographic characteristics,tic disorders condition,Tiapride usage and treatment of the children,this study may provide reference for the clinical diagnosis and treatment decision of gradually reducing and stopping Western medicine in the treatment of tic disorders by integrated Chinese and Western medicineMethods:This study has investigated and analyzed data by retrospective study,based on the medical records of TD children conforming to the inclusion and exclusion standards.The TD research medical records established by the pediatric outpatient department of Guang ’anmen Hospital from May 2020 to December 2022 were collected,including the demographic data,disease characteristics,treatment status,Tiapride usage and therapeutic effect of TD children,to analyze and compare the differences of therapeutic effect of different Tiapride reduction programs,so as to explore advantageous drug reduction programme.The factors that may affect the total dose and rate of Tiapride reduction were analyzed by single factor analysis,and the significant factors were analyzed by multiple regression analysis,in order to guide clinical decision-making.Results:1 General situation of TD cases:There were 86 boys(21.10%)and 23 girls(78.90%)in all TD children.The average age of seeing the doctor newly was(8.76±2.28)years old.The average course of TD was(33.02±26.09)months old.Most of the tic types were motor-vocal combined tic(67 cases,61.47%).The severity of TD was mainly moderate(69 cases,63.30%).Most of the types of TCM syndromes were liver-lung wind and heat syndrome(67 cases,61.47%).The average dosage of Tiapride before TCM treatment was(207.34±109.73)mg/d.The average duration of Tiapride before TCM treatment was(10.44±12.61)months.98 cases(89.91%)took traditional Chinese medicine regularly and 11 cases(10.09%)didn’t.99 cases(90.83%)reduced Tiapride on doctor’s orders and 10 cases(9.17%)didn’t.16 cases(14.68%)used other Western medicine and 93 cases(85.32%)didn’t.The average frequency of return visit to adapt TCM prescription was(2.89±1.67).2 After 12 weeks of Tiapride plus TCM treatment,the total effective rate was 80.73%,and the total remarkable effective rate was 25.69%.The rate of TD children who reduced Tiapride was 91.74%.3 The programme elements of Tiapride reduction:The total effective rate in the first reduction dose "25 mg/d" group was higher than that in the "non-25 mg/d" group(P=0.035<0.05).The incidence rate of relapse in the average dose of a single dose reduction "25 mg/d"group was lower than that in the "non-25 mg/d",group(P=0.044<0.05).The YGTSS improvement rate in the first reduction course "6～11.9 weeks" group was lower than that in the other groups(P<0.05).The YGTSS improvement rate in different groups of average course of a single dose reduction had significant difference(P=0.002<0.01),and the average showed a decreasing trend with the prolonging of the average course of a single dose reduction.The YGTSS improvement rate in different groups of the frequency of drug reduction had significant difference(P=0.000<0.01).When the number of reduction was 0～5 times,the average of YGTSS improvement rate showed an increasing trend with the increase of the number of reduction,and decreased when the number of reduction was 6 times.The average of YGTSS improvement rate reached the maximum when the number of reduction was 5 times.4 The rate of mild or moderate TD children in the unreduced group was lower than that in the reduced group(P=0.034<0.05),and the effective rate in the unreduced group was higher than that in the reduced group(P=0.002<0.01).5 In this study,the incidence rate of relapse induced by Tiapride reduction was 17.00%.6 Influencing factors of the dose of Tiapride reduction:Univariate analysis showed that the reduced dose of Tiapride was negatively correlated with YGTSS score before TCM treatment(r=-0.189),and was positively correlated with the dose of Tiapride before TCM treatment(r=0.247),and was related to the withdrawal of Western medicine without compliance(r=0.575).There was statistical significance in the dose of Tiapride reduction in different frequency of return visits(P=0.016<0.05).Multivariate analysis showed that the multiple linear regression equation can be expressed as the dose of Tiapride reduction=121.164*withdrawal of Western medicine without compliance+0.152*Tiapride dose before TCM treatment+8.783*the frequency of return visits-1.188*YGTSS score before TCM treatment+52.979(F=24.580,P=0.000<0.05,R2=0.466).7 Influencing factors of the reduction rate of Tiapride:Univariate analysis showed that the reduction rate of Tiapride was negatively correlated with age(r=-0.257),course of TD(r=-0.248),YGTSS score before TCM treatment(r=-0.208),the severity of TD before TCM treatment(rs=-0.253),duration of Tiapride before TCM treatment(r=-0.278),and the dose of Tiapride before TCM treatment(r=-0.530),and was positively correlated with frequency of return visits(r=0.230),and was related to the withdrawal of Western medicine without compliance(r=0.373).Multivariate analysis showed that the multiple linear regression equation could be expressed as the reduction rate of Tiapride=-0.002*the dose of Tiapride before TCM treatment+0.477*withdrawal of Western medicine without compliance+0.050*the frequency of return visits-0.005*YGTSS score before TCM treatment+0.790(F=26.863,P=0.000<0.01,R2=0.489).8 The dose of Tiapride reduction was significantly higher in the children who didn’t reduce Tiapride on doctor’s orders(P=0.000<0.01),and the reduction rate of Tiapride was significantly higher than that in the children who did(P=0.000<0.01).There was no significant difference in YGTSS improvement rate between the two groups(P=0.759>0.05).The incidence rate of relapse induced by Tiapride reduction in the children who didn’t reduce Tiapride on doctor’s orders was higher than that in the children who did(P=0.013<0.05).9 There was statistical significance in different dose of Tiapride reduction among children with different frequency of return visits(P=0.016<0.05).When the frequency of return visits was no more than 5 times,the median of Tiapride reduction dose showed an overall increasing trend with the increase of the frequency of return visits,and began to decrease when the frequency of return visits was 6 times.The median of Tiapride reduction dose reached the maximum when the number of return visits was 4 or 5 times,both of them were 100 mg/d.Conclusion:1 Within 12 weeks of Tiapride plus Jingxinzhidong Decoction treatment on TD children,It is feasible to reduce Tiapride gradually with the remission of the disease,which can meet the demand of drug reduction and achieve better therapeutic effect.2 The preliminary advantageous programme of Tiapride reduction:Ⅰ.The single reduction dose is 25 mg/d;.The interval of every single reduction should be maintained for at least 2 weeks;Ⅲ.Based on the obvious remission of TD,the evaluation criteria is that the tic score and(or)damage score of YGTSS decreased by more than 50%compared with the previous level.During treatment,if the YGTSS score remained basically unchanged or increased than before,the drug reduction should be stopped,and it will be continued when the YGTSS score continues to decline until stopping Tiapride.3 Compared with the children with drug reduction,the tic condition of the children without drug reduction is more severe,and the total effective rate is lower.It may has a tendency to be difficult to treat,and clinical attention should be paid to their follow-up diagnosis and treatment.4 The influencing factors of the dose and rate of Tiapride reduction mainly include"YGTSS score before TCM treatment","dose of Tiapride before TCM treatment","frequency of return visits" and "whether reduce Tiapride on doctor’s orders".5 The behavior of doesn’t reduce Tiapride on doctor’s orders will not affect the efficacy,but will affect the stability of tic,that prone to relapse after Tiapride reduction.6 4 to 5 return visits may be more advantageous for the occurring higher dose of Tiapride reduction.The average frequency of return visits is once every 2 to 2.4 weeks. |
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