Peterson B S, Leckman J F, Tucker D, Scahill L, Staib L, Zhang H, King R, Cohen D J, Gore J C, Lombroso P
Yale Child Study Center, New Haven, Conn 06520, USA.
Arch Gen Psychiatry. 2000 Apr;57(4):364-72. doi: 10.1001/archpsyc.57.4.364.
Previous studies have provided preliminary serological evidence supporting the theory that symptoms of tic disorders or obsessive-compulsive disorder (OCD) may be sequelae of prior streptococcal infection. It is unclear, however, whether previously reported associations with streptococcal infection were obscured by the presence of diagnostic comorbidities. It is also unknown whether streptococcal infection is associated in vivo with anatomical alterations of the brain structures that have been implicated in the pathophysiology of these disorders.
Antistreptococcal antibody titers were measured in 105 people diagnosed as having CTD, OCD, or attention-deficit/hyperactivity disorder (ADHD) and in 37 community controls without a disorder. Subjects were unselected with regard to their history of streptococcal exposure. Basal ganglia volumes were measured in 113 of these subjects (79 patients and 34 controls).
A DSM-IV diagnosis of ADHD was associated significantly with titers of 2 distinct antistreptococcal antibodies, antistreptolysin O and anti-deoxyribonuclease B. These associations remained significant after controlling for the effects of CTD and OCD comorbidity. No significant association was seen between antibody titers and a diagnosis of either CTD or OCD. When basal ganglia volumes were included in these analyses, the relationships between antibody titers and basal ganglia volumes were significantly different in OCD and ADHD subjects compared with other diagnostic groups. Higher antibody titers in these subjects were associated with larger volumes of the putamen and globus pallidus nuclei.
These findings suggest that the prior reports of an association between antistreptococcal antibodies and either CTD or OCD may have been confounded by the presence of ADHD. They also support the hypothesis that in susceptible persons who have ADHD or OCD, chronic or recurrent streptococcal infections are associated with structural alterations in basal ganglia nuclei.
先前的研究提供了初步的血清学证据，支持抽动障碍或强迫症（OCD）的症状可能是先前链球菌感染后遗症的理论。然而，尚不清楚先前报道的与链球菌感染的关联是否因诊断合并症的存在而被掩盖。也不清楚链球菌感染在体内是否与这些疾病病理生理学中涉及的脑结构解剖学改变有关。
对105名被诊断患有慢性抽动障碍（CTD）、强迫症或注意力缺陷多动障碍（ADHD）的人和37名无疾病的社区对照者测量抗链球菌抗体滴度。受试者未根据其链球菌接触史进行选择。对其中113名受试者（79名患者和34名对照）测量基底神经节体积。
ADHD的DSM-IV诊断与两种不同的抗链球菌抗体，即抗链球菌溶血素O和抗脱氧核糖核酸酶B的滴度显著相关。在控制CTD和OCD合并症的影响后，这些关联仍然显著。在抗体滴度与CTD或OCD的诊断之间未发现显著关联。当将基底神经节体积纳入这些分析时，与其他诊断组相比，OCD和ADHD受试者的抗体滴度与基底神经节体积之间的关系显著不同。这些受试者中较高的抗体滴度与壳核和苍白球核的较大体积相关。
这些发现表明，先前关于抗链球菌抗体与CTD或OCD之间关联的报道可能因ADHD的存在而混淆。它们还支持这样的假设，即在患有ADHD或OCD的易感人群中，慢性或复发性链球菌感染与基底神经节核的结构改变有关。
