[Correlation between serum 25-hydroxyvitamin D level and core symptoms of autism spectrum disorder in children].

Objective: To explore the relationship between serum 25-hydroxyvitamin D levels and core symptoms of autism spectrum disorder (ASD) in children. Method: In this cross-sectional study, ASD children 4 to 6 years of age who were diagnosed in Department of Developmental and Behavioral Pediatrics, First Hospital of Jilin university from January to May 2017 were assigned to ASD group, and children for routine growth and development assessment in Jilin province were assigned to control group. The two groups were well matched for age and sex, and none of them had received vitamin D supplementation. Serum 25-hydroxyvitamin D levels were measured by HPLC-MS/MS method. The patients of the ASD group were assessed with autism behavior checklist (ABC), childhood autism rating scale (CARS), social response scale (SRS), and autism treatment evaluation checklist (ATEC). The levels of vitamin D were divided into normal(>0.03 ng/L), insufficient (0.01-0.03 ng/L) and deficient (<0.01 ng/L). Levels of serum vitamin D between the two groups were compared by two independent sample t-test, and the difference in the percentages of normal, insufficient and deficient levels of vitamin D was tested by chi-square test, and correlations between vitamin D levels and the total scores or subscales of ABC, CARS, SRS and ATEC were analyzed by Pearson correlation analysis. Result: The 87 subjects in the ASD group included 75 males and 12 females, with a mean (±SD) age of (4.7±0.7) years. The 301 subjects in the control group included 249 males and 52 females, with a mean (±SD) age of (4.8±0.8) years. Serum vitamin D level in ASD children was significantly lower than that of the control group ( (0.021±0.008) vs. (0.036±0.016) ng/L, t=-8.17, P<0.01), and the between-group percentage difference of normal, insufficient and deficient levels of vitamin D was statistically significant (12 (14%) vs. 186 (62%) , 67 (77%) vs. 113 (37%) , 8 (9%) vs. 2 (1%) , χ(2)=72.1, P<0.01). There were negative correlations between serum vitamin D level in ASD children and total ABC score or ABC subscale scores (body behavior, self-care, language and social interaction)(r=-0.531,-0.397,-0.283,-0.248,-0.262, P=0.000, 0.000, 0.007, 0.020, 0.014). There were negative correlations between serum vitamin D level in ASD children and total CARS score and CARS subscale scores (imitation, nonverbal communication and general impression) (r=-0.352, -0.216, -0.248, -0.216, P=0.001, 0.046, 0.021, 0.046). There were negative correlations between serum vitamin D level in ASD children and SRS behavior subscale or ATEC social interaction subscale (r=-0.536, P=0.005, r=-0.400, P=0.014). Conclusion: Serum 25-hydroxyvitamin D level in children with ASD is obviously lower than that in the healthy control group, and there are negative correlations between vitamin D levels and core symptoms of ASD. Trial registration Chinese Clinical Trial Registry, ChiCTR-CCC-13004498.目的： 探讨孤独症谱系障碍（ASD）患儿血清维生素D水平与孤独症症状之间的相关性。 方法： 采用横断面研究的方法，选取2017年1至5月就诊于吉林大学第一医院发育行为儿科的4~6岁近期未补充维生素D制剂的ASD患儿作为ASD组，同期4~6岁且性别分布情况与ASD组匹配的近期未补充维生素D制剂的吉林省内体检的儿童作为对照组。采用高效液相色谱-串联质谱法检测两组儿童血清25(OH)D水平，并对ASD组患儿进行孤独症行为量表（ABC）、儿童孤独症评定量表（CARS）、社会反应量表（SRS）、孤独症治疗评估量表（ATEC）的评估。维生素D的营养情况分为正常（>0.03 ng/L）、不足（0.01~0.03 ng/L）和缺乏（<0.01 ng/L）。采用独立样本t检验的方法比较两组维生素D的水平；采用χ(2)检验的方法比较两组不同维生素D的营养情况的差异；采用Pearson相关性分析的方法分析ASD组患儿维生素D水平与ABC、CARS、SRS、ATEC的总分及其各个亚区分数的相关性。 结果： 符合入组条件的ASD组患儿87例[男75例、女12例，平均年龄（4.7±0.7）岁]，对照组301名[男249名、女52名，平均年龄（4.8±0.8）岁]。ASD组患儿维生素D水平显著低于对照组[（0.021±0.008）比（0.036±0.016）ng/L, t=-8.17，P<0.01]，两组间维生素D水平正常、不足和缺乏的率的比较差异有统计学意义[12例（14%）比186例（62%），67例（77%）比113例（37%），8例（9%）比2例（1%），χ(2)=72.1，P<0.01]。ASD组维生素D水平与ABC总分、躯体行为、生活自理、语言、交往能区均呈负相关（r=-0.531、-0.397、-0.283、-0.248、-0.262，P=0.000、0.000、0.007、0.020、0.014）；与CARS总分、模仿、非语言交流、整体印象能区均呈负相关（r=-0.352、-0.216、-0.248、-0.216，P=0.001、0.046、0.021、0.046）；与SRS行为能区、ATEC社交能区亦均呈负相关（r=-0.536、-0.400, P=0.005、0.014）。 结论： ASD患儿血清维生素D水平较健康儿童明显低，与ASD多种核心症状之间存在显著的相关关系。临床试验注册中国临床试验注册中心，ChiCTR-CCC-13004498。.