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孤独症谱系障碍儿童血清微量元素水平与核心症状间关系的全国多中心调查
张鑫慧, 杨亭, 陈洁, 陈立, 代英, 贾飞勇, 武丽杰, 郝燕, 李玲, 张婕, 柯晓燕, 衣明纪, 洪琦, 陈津津, 方拴锋, 王益超, 王琦, 金春华, 李廷玉
中国当代儿科杂志 ›› 2021, Vol. 23 ›› Issue (5) : 445-450.
PDF(1138 KB)
PDF(1138 KB)
孤独症谱系障碍儿童血清微量元素水平与核心症状间关系的全国多中心调查
Association between serum trace elements and core symptoms in children with autism spectrum disorder: a national multicenter survey
目的 探讨孤独症谱系障碍（autism spectrum disorder，ASD）儿童的血清微量元素水平与ASD核心症状之间的关系。方法 2018年9月至2019年9月在中国13个城市三级甲等医院门诊和特殊教育机构调查了1 020例ASD儿童和1 038例年龄、性别相匹配的健康儿童，采用孤独症行为量表、社交反应量表和孤独症评定量表评估ASD儿童的核心症状，采用电感耦合等离子体质谱法测定血清微量元素镁、铁、铜、锌的水平。结果 ASD儿童的血清镁、铜和锌水平显著低于健康儿童（均P < 0.05）。重度ASD儿童的血清镁和锌水平显著低于轻-中度ASD儿童（均P < 0.05）。偏相关分析结果显示，血清镁水平与孤独症行为量表总分、交往能力得分呈负相关（分别r=-0.318、0.282，均P < 0.001）；血清锌水平与孤独症行为量表总分、交往能力得分及躯体运动得分呈负相关（分别r=-0.221、-0.270、-0.207，均P < 0.001）。结论 血清镁和锌水平与ASD儿童核心症状具有一定关联，但这种关联的意义需要进一步研究；临床上应注意监测ASD儿童的微量元素营养状况。
Objective To study the association of serum levels of trace elements with core symptoms in children with autism spectrum disorder (ASD). Methods From September 2018 to September 2019, an investigation was performed for 1 020 children with ASD and 1 038 healthy children matched for age and sex in the outpatient service of grade A tertiary hospitals and special education institutions in 13 cities of China. Autism Behavior Checklist (ABC), Social Responsiveness Scale (SRS), and Childhood Autism Rating Scale (CARS) were used to assess the core symptoms of the children with ASD. The inductively coupled plasma mass spectrometry was used to measure serum levels of trace elements magnesium, iron, copper, and zinc. Results The children with ASD had significantly lower serum levels of magnesium, copper, and zinc than the healthy children (P < 0.05). The children with severe ASD had significantly lower serum levels of magnesium and zinc than those with mild-to-moderate ASD (P < 0.05). The results of partial correlation analysis showed that serum magnesium level was negatively correlated with the total score of ABC and the score of communication (r=-0.318 and -0.282 respectively; P < 0.001), and serum zinc level was negatively correlated with the total score of ABC and the scores of communication and somatic movement (r=-0.221, -0.270, and -0.207 respectively; P < 0.001). Conclusions The serum levels of magnesium and zinc may be associated with core symptoms in children with ASD, which requires further studies. The nutritional status of trace elements should be monitored for children with ASD in clinical practice.
Autism spectrum disorder / Trace element / Core symptom / Child
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国家自然科学基金面上项目（81771223）；广东省科技重大专项“自闭症诊疗方法研究”（2018B030335001）；广州市科技计划“孤独症谱系障碍早期诊疗技术”（202007030002）。
