抽動及共患注意缺陷多動障礙患兒維生素D含量差異研究

［摘 要］目的 探討血清維生素D含量與抽動障礙（TD）發病及共患注意缺陷多動障礙（ADHD）的關系。方法 選取2021年4月至2023年4月于攀枝花市中心醫院兒科門診確診為TD的161名兒童為研究對象，根據是否共患ADHD分為單純TD組（n=103）、TD+ADHD組（n=58），比較兩組患兒維生素D含量差異情況。結果 不同性別TD兒童25（OH）D含量無顯著性差異（P＞0.05）；病程＞12個月的TD兒童25（OH）D含量低于病程≤12個月的TD兒童，差異具有統計學意義（t=3.02，P＜0.05）；病程＞12個月組TD兒童血清25（OH）D不足比例高于病程≤12個月組，差異有統計學意義（χ2=6.88，P＜0.05）；中重度TD兒童的25（OH）D含量明顯低于輕度TD兒童（t=3.64，P＜0.05）；中重度TD組兒童血清25（OH）D不足及缺乏比例明顯高于輕度TD組，差異有統計學意義（χ2=18.23，P＜0.05）；TD+ADHD兒童與單純TD兒童的25（OH）D含量差異無統計學意義（P＞0.05）；TD+ADHD組兒童血清25（OH）D不足及缺乏比例高于單純TD組，差異有統計學意義（χ2=3.85，P＜0.01）。結論 維生素D缺乏程度與TD的病情、病程及合并ADHD的風險呈正相關性。

［關鍵詞］抽動障礙；注意缺陷多動障礙；維生素D；兒童

Doi：10.3969/j.issn.1673-5293.2024.09.011

［中圖分類號］R179""" ［文獻標識碼］A

［文章編號］1673-5293（2024）09-0071-05

Study on differences in vitamin D levels in children with tics and

comorbid attention deficit hyperactivity disorder

［Abstract］ Objective To investigate the relationship between serum vitamin D levels and the onset of tic disorder （TD） and comorbid attention deficit hyperactivity disorder （ADHD）. Methods A total of 161 children diagnosed with TD at the pediatric outpatient department of Panzhihua Central Hospital from April 2021 to April 2023 were selected as study subjects.According to whether they had comorbid ADHD，they were divided into the simple TD group （n=103） and the TD+ADHD group （n=58）.The differences in vitamin D levels between the two groups were compared. Results There was no significant difference in 25（OH）D levels between TD children of different genders （P＞0.05）.TD children with a disease course of ＞ 12 months had lower 25（OH）D levels than those with a disease course of ≤ 12 months，with a statistically significant difference （t=3.02，P＜0.05）.The proportion of TD children with insufficient serum 25（OH）D levels in the ＞ 12 months group was higher than that in the ≤ 12 months group，with a statistically significant difference （χ2=6.88，P＜0.05）.The 25（OH）D levels in children with moderate to severe TD were significantly lower than those in children with mild TD （t=3.64，P＜0.05）.The proportion of children with insufficient and deficient serum 25（OH）D in the moderate to severe TD group was significantly higher than that in the mild TD group，with a statistically significant difference （χ2=18.23，P＜0.05）.There was no statistically significant difference in 25（OH）D levels between children with TD+ADHD and those with simple TD （P＞0.05）.The proportion of children with insufficient and deficient serum 25（OH）D levels in the TD+ADHD group was higher than that in the simple TD group，with a statistically significant difference （χ2=3.85，P＜0.01）. Conclusion The degree of vitamin D deficiency is positively correlated with the severity，disease course，and risk of comorbid ADHD in TD.

［Key words］ tic disorder;attention deficit hyperactivity disorder;vitamin D;children

抽動障礙（tic disorders，TD）是一種多發于兒童或青少年時期的神經精神障礙性疾病，主要表現為突然的、快速的、反復出現的、無節律的運動或/和發聲抽動，患病率約為1%［1］。TD的病因尚不清楚，可能是遺傳、神經生理、神經生化和環境因素相互作用的結果［2-3］。TD的常見共患病包括注意缺陷多動障礙（attention deficit hyperactivity disorder，ADHD）、焦慮癥和強迫癥等。ADHD指發生于兒童時期，與同齡兒童相比，以明顯注意集中困難、注意持續時間短暫、活動過度或沖動為主要特征的一組綜合征。Marwitz等［4］對TD患兒的合并癥發生率進行評估，結果顯示ADHD發生率最高，為37%。……