目的 分析维生素D(VD)与抽动障碍(TD)症状严重程度、临床分型的关系,为TD综合诊治提供临床依据。方法 对2020年3—11月就诊于上海交通大学医学院附属上海儿童医学中心专科门诊的225例TD患儿(TD组)和228例健康体检儿童(对照组)进行回顾性分析,根据耶鲁综合抽动严重程度量表(YGTSS),TD组儿童分为轻度TD组(≤25分)和中重度TD组(＞25分),根据DSM-5临床分型标准,将TD儿童分为一过性抽动障碍(PTD)组、慢性抽动障碍(CTD)组和Tourette综合征(TS)组。分析维生素D缺乏与TD发生发展的相关性。结果 TD组VD水平显著低于对照组[(22.18±6.29)ng/ml,(26.14±6.48)ng/ml,t=6.60,P<0.001],VD不足或缺乏比例(89.8%)显著高于对照组(75.9%),差异有统计学意义(χ2=15.35,P<0.001)。中重度TD组VD水平低于轻度TD组和对照组(F=23.85,P＜0.001)。TD儿童VD水平与症状严重程度呈负相关(r=-0.215,P=0.001)。TD的三组临床亚型与对照组VD水平差异有统计学意义(F=16.93,P<0.001),其中,CTD组VD水平最低,其含量显著低于对照组,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=15.91,P<0.001)。 结论 VD缺乏在TD患儿中比较普遍。TD儿童VD缺乏程度与TD症状严重程度、临床亚型存在一定相关性。维生素D水平的检测可为TD的辅助治疗提供新的临床思路。
Abstract
Objective To explore the association of vitamin D(VD) level with tic disorder (TD) symptom severity and clinical classification, in order to provide evidence for comprehensive diagnosis and treatment of TD. Methods From March 2020 to November 2020, a total of 225 TD children (TD group) and 228 healthy children (control group) in Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, were retrospectively enrolled in this study. According to the Yale Global Tic Severity Scale (YGTSS), children in the TD group were divided into mild TD group (≤25 points)and moderate to severe TD group(＞25 points). According to the DSM-Ⅴ clinical classification standard, children with TD were divided into provisional tic disorder group (PTD group), chronic tic disorder group (CTD group) and Tourette syndrome group (TS group). The correlation between vitamin D deficiency and the development of TD was analyzed. Results Serum VD level of children in TD group was significantly lower than that of the control group[(22.18±6.29) ng/ml,(26.14±6.48) ng/ml, t=6.60,P<0.001], and the proportion of insufficient or lacking VD (89.8%) was high in the control group (75.9%) (χ2=15.35, P<0.001). Serum VD level of the moderate to severe TD group was lower than that of the mild TD group and the control group (F=23.85, P<0.001). Serum VD level of TD children was negatively related to the severity of symptoms (r=-0.215, P=0.001). The difference in VD levels among three clinical subtypes of TD and the control group was statistically significant (F=16.93, P<0.001). Among them, the CTD group had the lowest VD level, which was significantly lower than the control group.The proportion of insufficient or lack of serum VDin children with TD subtypeswas higher than that of the control group (χ2=15.91, P<0.001). Conclusions VD deficiency is more common in children with TD. There is a certain correlation between the degree of VD deficiency and the severity of tic disorder symptoms and clinical subtypesin children with TD. The detection of vitamin D level can be used as an auxiliary examination for children with TD, providing new clinical ideas for the treatment of TD.
关键词
抽动障碍 /
维生素D /
儿童 /
临床亚型 /
严重程度
Key words
tic disorder /
vitamin D /
children /
clinical subtypes /
severity
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参考文献
[1] 杨晓燕,侯成,衣明纪. 维生素D在儿童抽动障碍中的神经生化与免疫机制研究进展[J].中国儿童保健杂志,2021,29(8):857-860.
[2] 孙云云,韩斐,杨晴晴,等.共患和不共患ADHD的抽动障碍患儿临床特征调查分析[J].中国儿童保健杂志,2020,29(1):97-100.
[3] Scharf JM,Miller LL,Gauvin CA,et al.Population prevalence of Tourette syndrome: a systematic review and meta-analysis[J].Mov Disord,2015,30(2):221-228.
[4] Luan W,Hammond LA,Vuillermot S,et al.Maternal vitamin D prevents abnormal dopaminergic development and function in a mouse model of prenatal immune activation[J].Sci Rep,2018,8(1):9741.
[5] Buse J,Schoenefeld K,Münchau A,et al.Neuromodulation in Tourette syndrome:Dopamine and beyond[J].Neurosci Biobehav R,2013,37(6):1069-1084.
[6] 陈先睿,黄建琪,陈玲,等.血清25羟维生素D水平在抽动障碍儿童中的临床研究[J].中国妇幼保健,2019,34(18):4228-4231.
[7] 侯成,杨召川,刘秀梅,等.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[J].中华行为医学与脑科学杂志,2020,29(4):308-309.
[8] 李洪华,王冰,单玲,等.抽动障碍患儿血清25羟基维生素D水平的检测[J].中国当代儿科杂志,2017,19(11):1165-1168.
[9] Li H,Xu Z,Wang B,et al.Clinical improvement following vitamin D3 supplementation in children with chronic tic disorders[J].Neuropsych Dis Treat,2019,15:2443-2450.
[10] 美国精神医学学会.精神障碍诊断与统计手册[M].张道龙,译.北京大学出版社,2016.
[11] 刘智胜,秦炯,王家勤,等.儿童抽动障碍诊断与治疗专家共识(2017实用版)[J].中华实用儿科临床杂志,2017,32(15):1137-1140.
[12] Leckman JF,Riddle MA,Hardin MT,et al.The Yale Global Tic Severity Scale:Initial testing of a clinician-rated scale of tic severity[J].J Am Acad Child Adolesc Psychiatry,1989,28(4):566-573.
[13] Godel JC,Canadian PS.Vitamin D supplementation: Recommendations for Canadian mothers and infants[J].Paediatr Child Health,2007,12(7):583-589.
[14] Hienert M,Gryglewski G,Stamenkovic M,et al.Striatal dopaminergic alterations in Tourette's syndrome: a meta-analysis based on 16 PET and SPECT neuroimaging studies[J].Transl Psychiatry,2018,8(1):143-149.
[15] Augustine F,Singer HS.Merging the pathophysiology and pharmacotherapy of Tics[J].Tremor Other Hyperkinet Mov (N Y),2018,8:595.
[16] Nespoli E,Rizzo F,Boeckers T,et al.Altered dopaminergic regulation of the dorsal striatum is able to induce tic-like movements in juvenile rats[J].PLoS One,2018,13(4):e196515.
[17] Nomura Y.Tourette syndrome: Clinical features and pathophysiology[J].Brain Nerve,2017,69(12):1373-1385.
[18] Caligiore D,Mannella F,Arbib MA,et al.Dysfunctions of the basal ganglia-cerebellar-thalamo-cortical system produce motor tics in Tourette syndrome[J].PLoS Comput Biol,2017,13(3):e1005395.
[19] Fu Y,Hu Y,Qin Z,et al.Association of serum 25-hydroxyvitamin D status with bone mineral density in 0-7 year old children[J].Oncotarget,2016,7(49):80811-80819.
[20] Esmaeili Dooki MR,Moslemi L,Moghadamnia AA,et al.Vitamin D status in preschool children:Should vitamin D supplementation,preventing vitamin D deficiency be continued in children over 2 years?[J].J Public Health(Oxf),2019,41(3):575-582.
[21] 王汐蕊,余晓丹,张丽珊,等.健康学龄前351名儿童25-羟维生素D水平及影响因素[J].中国儿童保健杂志,2020,28(10):1101-1105.
[22] Li H,Shan L,Wang B,et al.Serum 25-hyroxyvitamin D levels and tic severity in Chinese children with tic disorders[J].Psychiat Res,2018,267:80-84.
[23] Muscogiuri G,Altieri B,Annweiler C,et al.Vitamin D and chronic diseases: the current state of the art[J].Arch Toxicol,2016,91(1):97-107.
[24] Kesby JP,Turner KM,Alexander S,et al.Developmental vitamin D deficiency alters multiple neurotransmitter systems in the neonatal rat brain[J].Int J Dev Neurosci,2017,62:1-7.
[25] 秦莹,仰曙芬.维生素D与脑发育相关研究进展[J].中国儿童保健杂志,2021,29(4):393-396.
[26] Szymczak I,Pawliczak R.The active metabolite of vitamin D3 as a potential immunomodulator[J].Scand J Immunol,2016,83(2):83-91.
[27] Verma R,Kim JY.1,25-Dihydroxyvitamin D3 facilitates M2 polarization and upregulates TLR10 expression on human microglial cells[J].Neuroimmunomodulation,2016,23(2):75-80.
基金
上海市中医药管理局(ZHYY-ZXYJHZX-201918);上海儿童医学中心项目(LY-SCMC2020-03)
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