血清25-(OH)D和维生素B12水平与孤独症谱系障碍儿童病情特征的相关性

doi:10.11852/zgetbjzz2023-0020

摘要/Abstract

摘要： 目的探究孤独症谱系障碍(ASD)儿童血清25-(OH)D和维生素B12水平及其与病情特征的相关性,为ASD的预防及治疗提供科学依据。方法回顾性分析2019年6月-2021年6月于肇庆市第一人民医院收治的ASD儿童100例作为观察组,随机选取在本院体检的健康儿童100例为对照组。比较两组患儿血清25-(OH)D、维生素B12水平,统计两组患儿及母亲孕期维生素D及维生素B12补充率水平差异,使用特征(ROC)曲线分析两组患儿血清25-(OH)D、维生素B12水平差异。使用Spearman相关性分析血清25-(OH)D、维生素B12水平变化与ASD严重程度的相关性。结果观察组患儿血清25-(OH)D、维生素B12水平、患儿及母亲孕期维生素D及维生素B12补充率均低于对照组(t=9.230、7.163,χ²=16.647、23.894、11.524、4.760,P＜0.05)。血清25-(OH)D、维生素B12水平均具备预测、评估ASD的价值(AUC=0.816、0.761,P＜0.05)。轻中度组患儿血清25-(OH)D、维生素B12水平均高于重度组(P＜0.05)。经Spearman相关性分析,ASD患儿病情严重程度与血清25-(OH)D、维生素B12水平负相关(r_s=-0.328、-0.301,P＜0.05)。结论 ASD儿童存在血清25-(OH)D、维生素B12异常,患儿及母亲孕期维生素D及B12补充率水平与ASD发病存在一定联系。ASD患儿及母亲孕期补充维生素D与B12可能对ASD的防治有一定效果。

关键词: 孤独症谱系障碍, 25-(OH)D, 维生素B12

Abstract: Objective To explore the levels of serum 25-(OH)D and vitamin B12 in children with autism spectrum disorders (ASD) and their correlation with disease characteristics,in order to provide a scientific basis for the prevention and treatment of ASD. Methods A total of 100 children with ASD treated in the First People's Hospital of Zhaoqing from June 2019 and June 2021 were retrospectively analyzed,and were selected as observation group.Another 100 healthy children who came to the hospital for physical examination were randomly enrolled as control group.The levels of serum 25-(OH)D and vitamin B12 of the children in two groups were compared,and the differences in supplementation rates of vitamin D and vitamin B12 during childhood and maternal pregnancy were statistically analyzed.Receiver operating characteristic (ROC) curve was used to analyze the differences in levels of serum 25-(OH)D and vitamin B12 of children in both groups.Spearman correlation analysis was adopted to explore the correlation between changes of levels of serum 25-(OH) D and vitamin B12 and severity of ASD. Results The levels of serum 25-(OH)D and vitamin B12 of children,the supplementation rates of vitamin D and vitamin B12 of children and mothers in the observation group were significantly lower than those in control group (t=9.230,7.163, χ²=16.647,23.894,11.524,4.760,P<0.05).The levels of serum 25-(OH)D and vitamin B12 had the value of predicting and evaluating ASD (AUC=0.816,0.761,P<0.05).The levels of serum 25-(OH)D and vitamin B12 of children with mild-to-moderate ASD were higher than those with severe ASD (P<0.05).Spearman correlation analysis found that the severity of ASD children was negatively correlated with levels of serum 25-(OH)D and vitamin B12 (r_s=-0.328,-0.301,P<0.05). Conclusions Children with ASD have abnormal serum 25-(OH) D and vitamin B12.The supplementation rates of vitamin D and vitamin B12 during childhood and maternal pregnancy are related to the incidence of ASD.Vitamin D and B12 supplementation during pregnancy may have a certain effect on preventing the treating of ASD in children.

Key words: autism spectrum disorders, 25-(OH)D, vitamin B12

中图分类号:

R749.94

黄天然, 刘姝娆, 张艳婷, 岑丽婷, 陆燕珍. 血清25-(OH)D和维生素B12水平与孤独症谱系障碍儿童病情特征的相关性[J]. 中国儿童保健杂志, 2024, 32(12): 1384-1388.

HUANG Tianran, LIU Shurao, ZHANG Yanting, CEN Liting, LU Yanzhen. Correlation of serum 25-(OH)D and vitamin B12 levels withseverity of autism spectrum disorder in children[J]. Chinese Journal of Child Health Care, 2024, 32(12): 1384-1388.

参考文献

[1] Mercati O,Huguet G,Danckaert A,et al.CNTN6 mutations are risk factors for abnormal auditory sensory perception in autism spectrum disorders[J].Molecular Psychiatry,2016,22(4):625-633.
[2] Sachin A,Rao SC,Bulsara MK,et al.Prevalence of autism spectrum disorder in preterm infants: A Meta-analysis[J].Pediatrics,2018(142):e20180134.
[3] 段小燕.维生素D与孤独症谱系障碍的关系[J].中国当代儿科杂志,2013,15(8):698-702.
Duan XY.Relationship between vitamin D and autism spectrum disorder[J].Chin Contemp Pediatr,2013,15(8):698-702.(in Chinese)
[4] 王萍,钟建民.维生素D在孤独症谱系障碍发病机制中的研究进展[J].中华实用儿科临床杂志,2021,36(2):158-160.
Wang P,Zhong JM.Advance on vitamin D in the pathogenesis of autism spectrum disorders[J].Chin J Appl Clin Pediatr,2021,36(2):158-160.(in Chinese)
[5] Morales DR,Slattery J,Evans S,et al.Antidepressant use during pregnancy and risk of autism spectrum disorder and attention deficit hyperactivity disorder: Systematic review of observational studies and methodological considerations[J].BMC Medicine,2018(16):6.
[6] 中华医学会儿科学分会发育行为学组,中国医师协会儿科分会儿童保健专业委员会,儿童孤独症诊断与防治技术和标准研究项目专家组.孤独症谱系障碍患儿常见共患问题的识别与处理原则[J].中华儿科杂志,2018,56(3):174-178.
Developmental Behavioral Group of Pediatrics Society of Chinese Medical Association,Professional Committee of Child Health Care of Pediatrics Society of Chinese Medical Doctor Association,Research Project Expert Group on Diagnosis and Treatment Technology and Standard of Childhood Autism.Principles of identification and management of common comorbidity problems in children with autism spectrum disorder [J].Chin J Pediatr,2018,56(3):174-178.(in Chinese)
[7] 应艳红,袁飒,鲜丹.孤独症谱系障碍儿童语言障碍的现状与影响因素分析[J].中国听力语言康复科学杂志,2020,18(3):208-210.
Ying YH,Yuan S,Xian D.The status and factors of language impairment in children with autism spectrum disorder[J].Chinese Scientific Journal of Hearing and Speech Rehabilitation,2020,18(3):208-210.(in Chinese)
[8] Doenyas C.Gut microbiota,inflammation,and probiotics on neural development in autism spectrum disorder[J].Neuroscience,2018(374): 271-286.
[9] Zhou T,Wang Y,Yi C.Affiliate stigma and depression in caregivers of children with autism spectrum disorders in China: Effects of self-esteem,shame and family functioning[J].Psychiatry Research,2018(264):260-265.
[10] 冯俊燕,李洪华,单玲,等.维生素D3联合早期介入丹佛模式治疗幼儿孤独症谱系障碍的疗效[J].中国当代儿科杂志,2019,21(4):337-341.
Feng JY,Li HH,Shan L,et al.Clinical effect of vitamin D3 combined with the Early Start Denver Model in the treatment of autism spectrum disorder in toddlers[J].Chin J Contemp Pediatr,2019,21(4):337-341.(in Chinese)
[11] 钟丽霞,熊喜悦.儿童孤独症谱系障碍人口统计学特征及相关危险因素分析[J].中国儿童保健杂志,2019,27(1):94-97.
Zhong LX,Xiong XY.Demographic characteristics and related risk factors of children with autism spectrum disorder[J].Chin J Child Health Care,2019,27(1):94-97.(in Chinese)
[12] 林晶晶,欧建君,陈琛.孕产期应激与孤独症谱系障碍:炎症反应的中介作用[J].国际精神病学杂志,2019,46(4):590-593.
Lin JJ,Ou JJ,Chen C.Maternal stress and autism spectrum disorders: The mediating role of inflammatory response[J].Journal of International Psychiatry,2019,46(4):590-593.(in Chinese)
[13] Cannell JJ.Vitamin D and autism,what's new?[J].Rev Endocr Metab Disord,2017,18(2):183-193.
[14] 吴梅荣,熊忠贵,金正江,等.25-羟维生素D维生素B12及叶酸对2～6岁孤独症谱系障碍儿童智力及核心症状的影响[J].中国妇幼保健,2021,36(11):2443-2446.
Wu MR,Xiong ZG,Jin JJ,et al.Effects of 25-hydroxyvitamin D,B,and folic acid on intelligence and core symptoms of 2~6 years'old children with autism spectrum disorder[J].Maternal and Child Health Care of China,2021,36(11):2443-2446.(in Chinese)
[15] 黄冠群,韩丁丁,仇慎峰,等.孤独症谱系障碍发病机制的研究进展[J].中国实用儿科杂志,2019,34(8):622-628.
Huang GQ,Han DD,Qiu SF,et al.Research progress in mechanisms underlying autism spectrum disorders[J].Chinese Journal of Practical Pediatrics,2019,34(8):622-628.(in Chinese)
[16] 张静,王凯旋,盛放,等.维生素D对孤独症谱系障碍儿童血清25-(OH)D水平肠道症状及肠道菌群失调的影响[J].中国妇幼保健,2020,35(23):4493-4495.
Zhang J,Wang KX,Sheng F,et al.Effects of vitamin D on serum 25-(OH)D level,intestinal symptoms and intestinal flora disorder in children with autism spectrum disorder[J].Maternal and Child Health Care of China,2020,35(23):4493-4495.(in Chinese)
[17] 邓成,陈昂,顾莉萍,等.中山市学龄前儿童孤独症谱系障碍及其影响因素调查[J].中国妇幼健康研究,2017,28(12):1537-1541.
Deng C,Chen A,Gu LP,et al.A survey of autism spectrum disorder and its influencing factors among preschool children in Zhongshan City[J].Chinese Journal of Woman and Child Health Research,2017,28(12):1537-1541.(in Chinese)
[18] 刘丹,余红.儿童孤独症谱系障碍环境危险因素研究进展[J].中国儿童保健杂志,2017,25(5):490-492.
Liu D,Yu H.Research progress of environmental risk factors of children's autism spectrumdisorder[J].Chin J Child Health Care,2017,25(5):490-492.(in Chinese)
[19] 余晓芳,李梅,郑艳.母亲孕期补充叶酸与其子女孤独症谱系障碍发病风险的Meta分析[J].中国当代儿科杂志,2017,19(3):286-291.
Yu XF,Li M,Zheng Y.Association between maternal folate supplementation during pregnancy and the risk of autism spectrum disorder in the offspring:A Meta analysis[J].Chin J Contemp Pediatr,2017,19(3):286-291.(in Chinese)
[20] 胡晓,徐海青.自闭症谱系障碍患儿血清维生素B12、同型半胱氨酸水平及其与病情严重程度的关系[J].广西医学,2020,42(21):2768-2770.
Hu X,Xu HQ.Serum vitamin B12 and homocysteine levels and their relation with severity of disease in children with autism spectrum disorder[J].Guangxi Medical Journal,2020,42(21):2768-2770.(in Chinese)