Li Erzhen, Ruan Yiyan, Chen Qian, Cui Xiaodai, Lv Lingyun, Zheng Ping, Wang Liwen
Neurology Department, Capital Institute of Pediatrics, Beijing, 100020, China,
Childs Nerv Syst. 2015 Jul;31(7):1157-63. doi: 10.1007/s00381-015-2692-8. Epub 2015 May 1.
Streptococcal infection and basal ganglia inflammation are hypothesized to be involved in Tourette's syndrome (TS). There is a need for effective therapies for managing TS. We studied streptococcal infection and immunity in TS following immunomodulator (pidotimod) therapy.
Blood samples from 58 patients with TS and 128 age-matched healthy controls enabled measurement of antistreptolysin O (ASO), T cells, natural killer (NK) cells, interleukin-6 (IL-6) and interleukin-8 (IL-8), and tumor necrosis factor-α (TNF-α). Forty-four patients with abnormal T cell numbers were divided into two groups and treated with pidotimod granules (pidotimod group, n = 20) or pidotimod plus dopaminergic receptor antagonists (combination group, n = 24). Yale Global Tic Severity Scale (YGTSS) scores and immunologic indices were assessed after treatment.
An ASO >1:200 was found in 22.4% of children with TS, 7.5% of controls, and 38.9% of children with both TS and attention deficit hyperactivity disorder (ADHD) compared to 15.0% of children with TS alone (P < 0.05). Children with TS showed decreased CD3(+) and CD4(+) T cells, CD4(+)/CD8(+) ratio, IL-6 and IL-8, increased NKC and TNF-α (P < 0.05) as compared to controls. ASO-positive children with TS had lower CD4(+) T cells as compared to ASO-negative children with TS, and lower IL-6 and IL-8 levels as compared to controls (P < 0.05). After 8 weeks of pidotimod treatment, IL-8 was increased compared to either tiapride hydrochloride or haloperidol and pidotimod (P < 0.05).
Streptococcal infection in TS patients is associated with immune and cytokine dysfunction, which can be potentially managed with immunomodulator therapy.
链球菌感染和基底神经节炎症被认为与抽动秽语综合征（TS）有关。需要有效的治疗方法来管理TS。我们研究了免疫调节剂（匹多莫德）治疗后TS患者的链球菌感染和免疫情况。
采集58例TS患者和128例年龄匹配的健康对照者的血样，检测抗链球菌溶血素O（ASO）、T细胞、自然杀伤（NK）细胞、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）和肿瘤坏死因子-α（TNF-α）。将44例T细胞数量异常的患者分为两组，分别给予匹多莫德颗粒治疗（匹多莫德组，n = 20）或匹多莫德联合多巴胺能受体拮抗剂治疗（联合组，n = 24）。治疗后评估耶鲁全球抽动严重程度量表（YGTSS）评分和免疫指标。
与仅患有TS的儿童的15.0%相比，22.4%的TS儿童、7.5%的对照儿童以及38.9%同时患有TS和注意力缺陷多动障碍（ADHD）的儿童ASO>1:200（P < 0.05）。与对照相比，TS儿童的CD3(+)和CD4(+) T细胞、CD4(+)/CD8(+)比值、IL-6和IL-8降低，NKC和TNF-α升高（P < 0.05）。与ASO阴性的TS儿童相比，ASO阳性的TS儿童CD4(+) T细胞较低，与对照相比IL-6和IL-8水平较低（P < 0.05）。匹多莫德治疗8周后，与盐酸硫必利或氟哌啶醇加匹多莫德相比，IL-8升高（P < 0.05）。
TS患者的链球菌感染与免疫和细胞因子功能障碍有关，免疫调节剂治疗可能对其有潜在的治疗作用。
