血清维生素A、维生素D与抽动障碍症状严重程度、临床类型的相关性研究

Correlation of serum vitamin A and vitamin D with the severity and clinical types of tic disorder

目的 探讨抽动障碍(Tic disorder,TD)患儿血清中维生素A(Vitamin A,VA)、维生素D(Vitamin,VD)水平及其与抽动症状严重程度、临床类型之间的关联,为更好地防治TD提供依据。方法 选取2018年9月至2019年4月就诊于青岛大学附属医院儿童保健科的TD患儿245例为病例组,同期行常规体检的健康儿童63例为对照组。检测VA、VD水平并分析其与抽动症状严重程度、临床类型之间的关系。结果 (1)病例组儿童VD水平明显低于对照组[(23.72±8.87) μg/L ,(26.61±7.59) μg/L,t=-2.24,P=0.03],VD不足或缺乏比例(37.31%,75/201)高于对照组(15.79%,9/57)(χ2=9.37,P=0.002)。(2)根据耶鲁综合抽动严重程度量表(Yale global tic severity scale,YGTSS),将病例组儿童分为轻度TD组、中重度TD组。①轻度TD组、中重度TD组与对照组血清VA、VD水平组间差异有统计学意义(F=29.79,P<0.01;F=10.90,P<0.01)。中重度TD组VA、VD水平低于轻度TD组和对照组[VA:(0.29±0.06)mg/L,(0.35±0.06)mg/L,(0.34±0.06)mg/L;VD:(21.01±8.30)μg/L,(25.84±8.76)μg/L,(26.61±7.59)μg/L]。②TD儿童VA、VD水平与症状严重程度呈负相关(r=-0.325;P<0.01;r=-0.228;P=0.001)。(3)根据DSM-V临床分型标准,将TD儿童分为PTD组、CTD组和TS组。①不同临床分型TD患儿血清VA水平差异无统计学意义(F=0.87,P=0.46)。②血清VD水平在四组间差异有统计学意义(F=4.13,P=0.007)。其中,TS组VD水平最低,其含量低于对照组[(21.83±7.60)μg/L ,(26.61±7.59)μg/L,P<0.05]。各亚型TD儿童血清VD含量不足或缺乏的比例高于对照组(χ2=10.88,P=0.01)。结论 TD儿童存在维生素D缺乏。TD患儿血清中维生素A、维生素D水平与症状程度有关,维生素D水平与TD临床类型相关。

Objective To explore the levels of vitamin A(VA)and vitamin D(VD)in blood of children with tic disorder(Tic disorder,TD)and their associations with tic symptoms severity and clinical types,so as to provide evidence for better prevention and treatment of TD.Methods A total of 245 children with TD from September 2018 to April 2019 in the department of child Health care,affiliated hospital of qingdao university were enrolled as the case group and 63 healthy children who underwent routine physical examination at the same time as the control group.The levels of VA and VD were measured and their relationship with the severity of tic symptoms and clinical types were analyzed.Results(1)The VD level of the case group was significantly lower than that of the control group((23.72±8.87)μg/L,(26.61±7.59)μg/L,t=-2.24,P=0.03),and the proportion of insufficiency or even lack(37.31%,75/201)was higher than the control group(15.79%,9/57)(χ2=9.37,P=0.002).(2)According to the Yale global tic severity scale(YGTSS),the children in the case group were divided into mild TD group,and moderate-to-severe TD group.①There were significant differences in serum VA and VD levels in mild TD group,moderate-to-severe TD group and the control group(F=29.79,P<0.01;F=10.90,P<0.01).Among them,the content of VA and VD in moderate-to-severe TD group were lower than those in mild TD group and control group(VA:(0.29±0.06)mg/L,(0.35±0.06)mg/L,(0.34±0.06)mg/L;VD:(21.01±8.30)μg/L,(25.84±8.76)μg/L,(26.61±7.59)μg/L).②VA and VD levels of children with TD were negatively correlated with the severity of symptoms(r=-0.325;P<0.01;r=-0.228;P=0.001).(3)According to DSM-V classification criteria,TD children were divided into PTD group,CTD group and TS group.①There was no significant difference in serum VA level among different clinical types of TD children(F=0.87,P=0.46).②The levels of serum VD were different among the four groups(F=4.13,P=0.007).Among them,the VD level in TS group was the lowest,and its content was significantly lower than that in control group((21.83±7.60)μg/L,(26.61±7.59)μg/L,P<0.05)).The prevalence of insufficient or even lack of serum VD in children with different subtypes of TD was higher than that in the control group(χ2=10.88,P=0.01).Conclusion Vitamin D deficiency exists in children with TD.The level of vitamin A and vitamin D in serum of children with TD is related with the severity of tic symptoms.The VD level is related with clinical type of TD.