卫生研究

目的研究叶酸及25-羟维生素D[25(OH)D]与孤独症患儿智力及核心症状关系。方法将齐齐哈尔医学院附属第四医院从2018年3月—2021年3月收治的124例3～6岁孤独症患儿作为病例组,选择同时期在医院进行体检的120例完全健康儿童作为对照组。分别在入院当日或体检当日采集两组儿童空腹静脉血4 mL,静置离心处理后放入-80℃冰箱保存,采用化学发光免疫分析以及高效液相色谱-串联质谱法检测两组儿童血清叶酸及25(OH)D水平,采用酶联免疫吸附法检测血清中叶酸代谢产物水平。对病例组和对照组儿童,采用韦氏幼儿及儿童智力量表(Wechsler scale for early childhood and child intelligence, WISC)对所有儿童的智力进行评估。采用孤独症儿童行为量表(behavior scale for autistic children, ABC)评估孤独症的核心症状。采用t检验法比较病例组和对照组儿童的血清叶酸和25(OH)D水平、WISC和ABC量表评分。以Pearson相关性分析明确血清叶酸、25(OH)D水平和孤独症患儿智力、核心症状的关系。结果病例组患儿血清叶酸及25(OH)D水平分别为(16.13±4.26)和(25.78±3.24)ng/mL,均低于对照组(21.58±5.37)和(36.94±6.11)ng/mL,差异均有统计学意义(P<0.05)。病例组WISC量表评分为(62.83±11.73)分,低于对照组的(89.42±12.58)分,而ABC量表评分为(77.39±10.28)分,高于对照组的(42.30±5.87)分,差异均有统计学意义(P<0.05)。经Pearson相关性分析可得:血清叶酸、25(OH)D水平与孤独症患儿WISC量表评分均呈正相关关系(r=0.512、0.584;P=0.012、0.001),而与ABC量表评分呈负相关关系(r=-0.546、-0.602;P=0.008、<0.001)。病例组血清中四氢叶酸(THFA)及5-甲基四氢叶酸(5-MTHF)水平分别为(3.85±1.22)和(4.84±1.32)ng/mL,均低于对照组的(4.30±1.51)和(5.34±1.34)ng/mL,而血清叶酸受体自身抗体(FRAA)水平为(433.29±74.34)pg/mL,高于对照组的(402.10±65.87)pg/mL,差异均有统计学意义(P<0.05)。结论孤独症患儿血清叶酸以及25(OH)D水平低于健康儿童,且血清叶酸以及25(OH)D和患儿智力以及核心症状密切相关,孤独症患儿智力越低,且核心症状越明显。

OBJECTIVE To study the relationship between folic acid and 25-hydroxy vitamin D[25(OH)D] and intelligence and core symptoms in children with autism. METHODS A total of 124 children with autism aged 3-6 years who were admitted to The Fouth Affiliated Hospital of Qiqihar Medical College from March 2018 to March 2021 were enrolled as the case group, and 120 healthy children who underwent physical examination in hospital during the same period were selected as the control group. Respectively in the hospital the same day or physical examination on two groups of children fasting venous blood collected 4 mL, let stand centrifugal after processing into-80 ℃ refrigerator, using chemiluminescence immunoassay and high performance liquid chromatography tandem mass spectrometry detection of two groups of children folic acid and serum 25(OH)D level, using enzyme-linked immunosorbent method to detect the serum level of folic acid metabolites. For the children in the case group and the control group, the Wechsler scale for early childhood and child intelligence(WISC) was used to assess intelligence. Core symptoms of autism were assessed using the behavior scale for autistic children(ABC). T test was used to compare serum folic acid and 25(OH)D levels, WISC and ABC scale scores between the case group and the control group. Pearson correlation analysis was conducted to determine the relationship between serum folic acid, 25(OH)D level and intelligence and core symptoms in children with autism. RESULTS The serum folic acid and 25(OH)D levels in the case group were(16.13±4.26) ng/mL and(25.78±3.24) ng/mL respectively, which were lower than those in the control group(21.58±5.37) ng/mL and(36.94±6.11) ng/mL, with statistical significance(all P<0.05). The WISC scale score of the case group was(62.83±11.73) points, lower than that of the control group(89.42±12.58) points, while the ABC scale score was(77.39±10.28) points, higher than that of the control group(42.30±5.87) points, with statistical significance(all P<0.05). Pearson correlation analysis showed that serum folic acid and 25(OH)D levels were positively correlated with WISC score(r=0.512, 0.584; P=0.012, 0.001), and was negatively correlated with ABC scale score(r=-0.546,-0.602; P=0.008, <0.001). The serum THFA and 5-MTHF levels in the case group were(3.85±1.22) ng/mL and(4.84±1.32) ng/mL respectively, which were lower than those in the control group(4.30±1.51) ng/mL and(5.34±1.34) ng/mL respectively. The serum FRAA level was(433.29±74.34) pg/mL, higher than that of the control group(402.10±65.87) pg/mL, with statistical significance(all P<0.05). CONCLUSION The serum folic acid and 25(OH)D levels are lower in children with autism, and are closely related to the intelligence and core symptoms of the children, that is, with the decline of the two serological indicators, the lower the intelligence of children with autism, and the more obvious the core symptoms.