孤独症谱系障碍患儿血清25(OH)D水平与临床症状的关系

Relationship between serum 25(OH)D levels and clinical symptoms in children with autism spectrum disorder

目的研究孤独症谱系障碍患儿血清25-羟基维生素D[25(OH)D]水平与临床症状的关系。方法前瞻性选取2019年12月至2020年12月河南中医药大学第一附属医院收治的65例儿童孤独症谱系障碍患儿(3~8岁)为试验组,选择同期来本院体检的健康小儿65名为对照组。比较试验组和对照组的一般资料(性别、年龄及生产方式、喂养方式、睡眠状况、胃肠道情况)及血清25(OH)D水平的差异。同时根据血清25(OH)D水平将孤独症谱系障碍患儿分为异常组(≤29 ng/mL,n=35)和正常组(≥30 ng/mL,n=30),比较异常组和正常组患儿在儿童孤独症评定量表(CARS)评分及血清25(OH)D水平上的差异,并分析血清25(OH)D水平与CARS评分的相关性。结果试验组和对照组性别构成比、早产构成比、剖腹产构成比、母乳喂养构成比及年龄比较,差异均无统计学意义(P>0.05);试验组偏食、便秘、呕吐、睡眠障碍、腹泻发生率均高于对照组,血清25(OH)D水平低于对照组,差异均有统计学意义(P<0.05)。异常组和正常组患儿的性别构成比、年龄、早产比例、剖腹产比例及母乳喂养比例比较,差异均无统计学意义(P>0.05);异常组呕吐、偏食、便秘、睡眠障碍、腹泻发生率均高于正常组,血清25(OH)D水平低于正常组,差异均有统计学意义(P<0.05)。异常组人际关系评分、模仿评分、情感反应评分、躯体运用能力评分、与非生命物体的关系评分、对环境变化的适应评分、视觉反应评分、听觉反应评分、一般印象评分及CARS总分均高于正常组,差异均有统计学意义(P<0.05)。经Pearson相关性分析结果显示,血清25(OH)D水平与模仿、人际关系、躯体运用能力、情感反应、对环境变化的适应、与非生命物体的关系、听觉反应、视觉反应、一般印象评分及CARS总分呈负相关(P<0.01)。结论血清25(OH)D水平低的孤独症谱系障碍患儿发生睡眠障碍及胃肠道问题的风险更大,且25(OH)D越低,患儿的临床症状越严重。

Objective To study the relationship between serum 25 hydroxyvitamin D[25(OH)D]levels and clinical symptoms in children with autism spectrum disorder.Methods Sixty-five children with autism spectrum disorder(aged 3-8 years)admitted to the First Affiliated Hospital of Henan University of Chinese Medicine from December 2019 to December 2020 were prospectively selected as the experimental group,and 65 healthy subjects were selected as the control group.The differences in general information(gender,age,mode of production,feeding method,sleep status,gastrointestinal condition)and serum 25(OH)D levels between the experimental group and the control group were compared.At the same time,the children with autism spectrum disorder were divided into abnormal group(≤29 ng/mL,35 cases)and normal group(≥30 ng/mL,30 cases)according to the serum 25(OH)D level.The differences of childhood autism rating scale(CARS)scores and serum 25(OH)D levels between abnormal group and normal group were compared.The correlation between serum 25(OH)D level and CARS score was analyzed.Results There were no statistically significant differences in gender,preterm birth,cesarean section,breastfeeding and age between the experimental group and the control group(P>0.05).The incidence of partial eating,constipation,vomiting,sleep disorders and diarrhea in the experimental group were higher than that in the control group,and the serum 25(OH)D level was lower than that in the control group(P<0.05).There were no statistically significant differences in gender composition,preterm birth,cesarean section,breastfeeding and age between abnormal group and normal group in 25(OH)D children with autism spectrum disorder(P>0.05).The incidence of vomiting,partial eating,constipation,sleep disorder and diarrhea in abnormal group were higher than those in normal group(P<0.05).The score of interpersonal relationship,imitation score,emotional response score,physical operation ability score,relationship score with inanimate objects,adaptation score to environmental change,visual response score,auditory response score,general impression score and total score of CARS in abnormal group were higher than those in normal group(P<0.05).By Pearson conelation analysis,serum 25(OH)D level were negatively correlated with imitation,interpersonal relationship,physical ability,emotional response,adaptation to environmental changes,relationship with inanimate objects,auditory response,visual response,general impression score and total CARS score(P<0.01).Conclusion Children with autism spectrum disorder with low serum 25(OH)D levels are at greater risk for sleep disturbances and gastrointestinal problems,and the lower the 25(OH)D level,the more severe the clinical symptoms.