儿童维生素A水平与抽动障碍的关系分析

Meta-analysis of the association between vitamin A levels and tic disorders in children

摘要

目的 系统评价抽动障碍(TD)与维生素A(VitA)水平的临床关系,为该病的预防提供新思路。方法 检索中国知网、维普、万方、PubMed、Cochrane Library及Web of Science数据库,检索时间从数据库建立至2025年1月12日。由2名研究者独立完成文献筛选、数据提取及文献偏倚风险评价,采用RevMan5.3软件进行Meta分析。结果 最终纳入文献7篇,样本总量1 401例,其中TD组901例,对照组500例。荟萃分析显示,TD组儿童血清VitA平均水平显著低于对照组(MD=-0.05,95%CI:-0.08～-0.02,P=0.002)。亚组分析显示:Tourette综合征(TS)组与慢性运动或发声抽动障碍(CTD)组儿童的血清VitA水平差异无统计学意义(MD=0.03,95%CI:-0.00～0.07,P=0.080);相比于TS组,暂时性抽动障碍(PTD)组儿童血清VitA水平更高(MD=0.05,95%CI:-0.00～0.09,P=0.050);PTD组儿童血清VitA水平显著高于CTD组(MD=0.01,95%CI:0.00～0.03,P=0.020)。3篇文献TD轻度组VitA水平显著高于中重度组(MD=0.08,95%CI:0.05～0.11,P<0.001)。结论 TD儿童的血清维生素A水平低于健康儿童,较低的维生素A水平可能与TD的发生及严重程度相关,但由于纳入研究数量有限且异质性较高,仍需更高质量研究进一步验证。

Abstract

Objective To systematically evaluate the association between vitamin A (VitA) levels and tic disorders (TD) in children, in order to provide new ideas for the prevention of TD. Methods CNKI, VIP, Wanfang, PubMed, Cochrane Library, and Web of Science were searched from inception to January 12, 2025. Two researchers independently screened the literature, extracted data, and assessed study quality. Meta-analysis was performed using RevMan 5.3. Results A total of 7 case-control studies involving 1 401 participants were included, including 901 children in the TD group and 500 in the control group. The pooled results showed that serum VitA levels in children with TD were significantly lower than those in healthy controls (MD=-0.05, 95%CI: -0.08 to -0.02, P=0.002). Subgroup analysis showed no significant difference in serum VitA levels between the Tourette syndrome (TS) group and the chronic motor or vocal tic disorder (CTD) group (MD=0.03, 95%CI:-0.00 to 0.07, P=0.080). Serum VitA levels in the provisional tic disorder (PTD) group tended to be higher than those in the TS group, with borderline significant difference (MD=0.05, 95%CI:-0.00 to 0.09, P=0.050). Serum VitA levels in PTD group were higher than those in CTD group(MD=0.01,95%CI:0.00 to 0.03,P=0.020). In 3 studies, VitA levels in children with mild TD were higher than those in children with moderate-to-severe TD (MD=0.08, 95%CI: 0.05 to 0.11, P<0.001). Conclusions Serum VitA levels are lower in children with TD than in healthy children, and lower VitA levels may be associated with the presence and severity of TD. However, given the limited number of included studies and the substantial heterogeneity, further high-quality studies are needed to confirm these findings.

关键词

抽动障碍 / 维生素A / Meta分析 / 儿童

Key words

tic disorders / vitamin A / Meta-analysis / children

[1] 刘智胜. 儿童抽动障碍[M]. 3版. 北京:人民卫生出版社, 2024.
[2] 卢青,孙丹,刘智胜. 中国抽动障碍诊断和治疗专家共识解读[J]. 中华实用儿科临床杂志,2021,36(9):647-653.
Lu Q,Sun D,Liu ZS.Interpretation of expert consensus for diagnosis and treatment of tic disorders in China[J].Chin J Appl Clin Pediatr,2021,36(9):647-653.(in Chinese)
[3] 张盼盼,曹凡,肖绪武.儿童过敏性疾病并发抽动障碍机制的研究进展[J].中国儿童保健杂志,2024,32(12):1333-1338.
Zhang PP,Cao F,Xiao XW.Advances in the possible mechanisms of tic disorders comorbid with allergic diseases in children[J].Chin J Child Health Care,2024,32(12):1333-1338.(in Chinese)
[4] 姜妍琳,张蔷,翟睿,等.中国儿童抽动障碍患病率及危险因素系统评价[J].中国儿童保健杂志,2023,31(6):661-667.
Jiang YL,Zhang Q,Zhai R,et al.Systematic review of the prevalence and risk factors of tic disorders in Chinese children[J].Chin J Child Health Care,2023,31(6):661-667.(in Chinese)
[5] Groth C,Skov L,Lange T,et al.Predictors of the clinical course of Tourette syndrome:A longitudinal study[J].J Child Neurol,2019,34:913-921.
[6] 赵荣香,罗尧竞,任丹.儿童多发性抽动症发病危险因素分析[J/CD].中华妇幼临床医学杂志(电子版),2017,13(2):177-182.
Zhao RX,Luo YJ,Ren D.Analysis of risk factors of children with Tourette syndrome[J/CD].Chin J Obstet Gynecol Pediatr(Electron Ed),2017,13(2):177-182.(in Chinese)
[7] 孙雪松,王丽敏,王禹,等.儿童抽动障碍与维生素A、D、B12水平的研究进展[J].微量元素与健康研究,2021,38(2):61-62.
[8] Shastak Y,Pelletier W.Vitamin A infish well-being:Integrating immune strength,antioxidant capacity and growth[J].Fishes,2024,9(8):330.
[9] 王爱珍,张振宇,李亚群,等.维生素A、D、E与抽动障碍的相关性研究[J].儿科药学杂志,2022,28(11):31-35.
Wang AZ,Zhang ZY,Li YQ,et al.Correlation between vitamin A,D and E and severity of tic disorder[J].Journal of Pediatric Pharmacy,2022,28(11):31-35.(in Chinese)
[10] 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):308-314.
Hou C,Yang ZC,Liu XM,et al.Correlation of serum vitamin A and vitamin D with the severity and clinical types of tic disorder[J].Chin J Behav Med Brain Sci,2020,29(4):308-314.(in Chinese)
[11] Margulis AV,Pladevall M,Riera-Guardia N,et al.Quality assessment of observational studies in a drug-safety systematic review,comparison of two tools:The Newcastle-Ottawa Scale and the RTI item bank[J].Clin Epidemiol,2014,6:359-368.
[12] 刘鸣.系统评价、Meta-分析设计与实施方法[M].北京:人民卫生出版社,2011:73.
[13] 刘守娟,乐原.血清总免疫球蛋白E、特异性免疫球蛋白E、维生素A、维生素D水平与儿童抽动障碍相关性分析[J].陕西医学杂志,2021,50(10):1257-1259,1263.
[14] 潘雪芸.维生素A、D水平与抽动障碍及其共患注意缺陷多动障碍的相关性分析[D].承德:承德医学院,2023.
Pan XY.Correlation analysis between vitamin A and D levels with tic disorders and their comorbidities attention deficit hyperactivity disorder[D].Chengde:Chengde Medical University,2023.(in Chinese)
[15] 杨振宇.自拟静心止动方治疗儿童抽动障碍及其对维生素A、E影响的研究[D].北京:北京中医药大学,2016.
[16] 卞秋翔,蒋本斌,田万通,等.维生素A、D及五维赖氨酸颗粒在抽动障碍儿童中的应用价值[J].河北医药,2020,42(23):3601-3604.
Bian QX,Jiang BB,Tian WT,et al.The application value of vitamin A/D and five-dimensiona lysine granulesin children with tic disorder[J].Hebei Medical Journal,2020,42(23):3601-3604.(in Chinese)
[17] Wang CX,Wang B,Sun JJ,et al.Circulating retinol and 25(OH)D contents and their association with symptoms in children with chronic tic disorders[J].Eur Child Adolesc Psychiatry,2024,33(4):1017-1028.
[18] 刘芳,叶静萍,姚宝珍,等.儿童抽动障碍与链球菌感染关系的Meta分析[J].医学研究杂志,2019,48(3):124-129,76.
Liu F,Ye JP,Yao BZ,et al.Meta-analysis of the relationship between tic disorder and streptococcal infection in children[J].J Med Res,2019,48(3):124-129,76.(in Chinese)
[19] 赵利平,胡晓红,李中原.儿童抽动障碍发病机制研究进展[J].发育医学电子杂志,2024,12(3):224-228.
Zhao LP,Hu XH,Li ZY.Research progress on pathogenesis of tic disorder in children[J].J Dev Med(Electronic Version),2024,12(3):224-228.(in Chinese)
[20] Tanumihardjo SA.Biological evidence to define a vitamin A deficiency cutoff using total liver vitamin A reserves[J].Exp Biol Med(Maywood),2021,246(9):1045-1053.
[21] Carazo A,Macáková K,Matoušová K,et al.Vitamin A update:Forms,sources,kinetics,detection,function,deficiency,therapeutic use and toxicity[J].Nutrients,2021,13(5):1703.
[22] Shibata M, Pattabiraman K, Lorente-Galdos B,et al. Regulation of prefrontal patterning and connectivity by retinoic acid[J].Nature,2021,598(7881):483-488.
[23] Wołoszynowska-Fraser MU,Rossi SL,Long JM,et al.Differential retinoic acid signaling in the hippocampus of aged rats with and without memory impairment[J].eNeuro,2021,8(5):120-121.
[24] Pan J,Yu J,Sun L,et al.ALDH1A1 regulates postsynaptic μ-opioid receptor expression in dorsal striatal projection neurons and mitigates dyskinesia through transsynaptic retinoic acid signaling[J].Sci Rep,2019,9(1):3602.
[25] Dumetz F,Buré C,Alfos S,et al.Normalization of hippocampal retinoic acid level corrects age-related memory deficits in rats[J].Neurobiol Aging,2020,85:1-10.
[26] Marie A,Leroy J,Darricau M,et al.Preventive vitamin A supplementation improves striatal function in 6-hydroxydopamine hemiparkinsonian rats[J].Front Nutr,2022,9:811843.
[27] Baldan LC, Williams KA, Gallezot JD,et al.Histidine decarboxylase deficiency causes tourette syndrome: Parallel findings in humans and mice[J].Neuron,2014,81(1):77-90.
[28] Bang YJ,Hu Z,Li Y,et al.Serum amyloid A delivers retinol to intestinal myeloid cells to promote adaptive immunity[J].Science,2021,373(6561):eabf9232.
[29] Liu X,Wang X,Zhang X,et al.Allergic diseases influence symptom severity and T lymphocyte subgroups of children with tic disorders[J].J Investig Med,2021,69(8):1453-1457.
[30] 汪琼,王国亮,韩斐,等.抽动障碍患儿T淋巴细胞亚群水平变化的分析[J].儿科药学杂志,2018,24(6):1-4.
Wang Q,Wang GL,Han F,et al.Changes of T lymphocyte subsets in tic disorders children[J].Journal of Pediatric Pharmacy,2018,24(6):1-4.(in Chinese)
[31] 王云.血清维生素A、D及铁蛋白水平与儿童抽动障碍的相关性研究[D].保定:河北大学,2024.
Wang Y.Correlation between serum vitamin A,vitamin D,and ferritin levels and tic disorders in children[D].Baoding:Hebei University,2024.(in Chinese)

基金资助

河北省医学科学研究课题计划项目(20211432);河北医科大学大学生创新性实验计划项目(USIP2024363)