Kurlan Roger, Johnson Dwight, Kaplan Edward L
University of Rochester School of Medicine, Mt Hope Professional Building, 1351 Mt Hope Ave, Suite 100, Rochester, NY 14620, USA.
Pediatrics. 2008 Jun;121(6):1188-97. doi: 10.1542/peds.2007-2657.
If pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections is a unique clinical entity, we hypothesized that children meeting diagnostic criteria would have more clinical exacerbations temporally linked to bona fide group A beta-hemolytic streptococcus infection than matched control subjects (chronic tic and/or obsessive-compulsive disorder with no known temporal relationship to group A beta-hemolytic streptococcus infection).
Subjects included 40 matched pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections case-control pairs who were prospectively evaluated with intensive laboratory testing for group A beta-hemolytic streptococcus and clinical measures for an average of 2 years. Additional testing occurred at the time of any clinical exacerbations or illness. Laboratory personnel were blinded to case or control status and clinical (exacerbation or not) condition. Clinical raters were blinded to the results of laboratory tests.
The cases had a higher clinical exacerbation rate and a higher bona fide group A beta-hemolytic streptococcus infection rate than the control group. Only 5 of 64 exacerbations were temporally associated (within 4 weeks) with a group A beta-hemolytic streptococcus infection, and all occurred in cases. The number (5.0) was significantly higher than the number that would be expected by chance alone (1.6). Yet, >/=75% of the clinical exacerbations in cases had no observable temporal relationship to group A beta-hemolytic streptococcus infection.
Patients who fit published criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections seem to represent a subgroup of those with chronic tic disorders and obsessive-compulsive disorder who may be vulnerable to group A beta-hemolytic streptococcus infection as a precipitant of neuropsychiatric symptom exacerbations. Group A beta-hemolytic streptococcus infection is not the only or even the most common antecedent event associated with exacerbations for these patients. Additional intensive studies are needed to determine whether there is clinical or scientific evidence to support separating out subgroups of tic disorder and/or obsessive-compulsive disorder patients based on specific symptom precipitants.
如果与链球菌感染相关的小儿自身免疫性神经精神障碍是一种独特的临床实体，我们推测符合诊断标准的儿童与匹配的对照受试者（慢性抽动和/或强迫症，与A组β溶血性链球菌感染无已知时间关系）相比，在时间上与真正的A组β溶血性链球菌感染相关的临床病情加重情况会更多。
受试者包括40对匹配的与链球菌感染相关的小儿自身免疫性神经精神障碍病例对照对，前瞻性地进行了平均2年的A组β溶血性链球菌强化实验室检测和临床测量。在任何临床病情加重或患病时进行额外检测。实验室人员对病例或对照状态以及临床（病情加重与否）情况不知情。临床评估人员对实验室检测结果不知情。
病例组的临床病情加重率和真正的A组β溶血性链球菌感染率高于对照组。64次病情加重中只有5次在时间上（4周内）与A组β溶血性链球菌感染相关，且均发生在病例组。该数字（5.0）显著高于仅由偶然因素预期的数字（1.6）。然而，病例组中≥75%的临床病情加重与A组β溶血性链球菌感染无明显的时间关系。
符合已发表的与链球菌感染相关的小儿自身免疫性神经精神障碍标准的患者似乎代表了慢性抽动障碍和强迫症患者中的一个亚组，他们可能易受A组β溶血性链球菌感染影响，从而引发神经精神症状加重。A组β溶血性链球菌感染并非这些患者病情加重的唯一甚至最常见的前驱事件。需要进行更多深入研究以确定是否有临床或科学证据支持根据特定症状诱发因素将抽动障碍和/或强迫症患者亚组区分开来。
