孤独症谱系障碍患儿血清叶酸及其代谢产物与维生素B12水平状况

探讨孤独症谱系障碍(autism spectrum disorder,ASD)患儿是否存在叶酸代谢异常,为建立ASD的早期预警信号和开展ASD儿童的靶向营养干预提供依据.方法 收集2015年10月-2016年9月期间在哈尔滨医科大学儿童发育行为研究中心就诊和接受康复训练,以及在本地某特教学校上学的典型ASD患者110名作为病例组,另选110名性别、年龄匹配的正常儿童青少年作为对照组.采用化学发光微粒子免疫技术(CMIA)检测2组儿童青少年血清中叶酸、维生素B12及同型半胱氨酸(Hcy)的浓度;应用酶联免疫吸附试验技术(ELISA)测定2组儿童青少年血清中叶酸代谢产物四氢叶酸(THFA)、5-甲基四氢叶酸(5-MTHF)、叶酸受体α(FRα)、叶酸受体自身抗体(FRAA)的含量,进行统计学分析.结果 ASD组血清叶酸和维生素B12的水平低于对照组,Hcy的水平高于对照组,差异均有统计学意义(t值分别为-3.12,-4.63,2.86,P值均<0.05);ASD组血清叶酸代谢产物5-MTHF的含量低于对照组,FRAA的含量高于对照组,差异均有统计学意义(t值分别为-2.28,2.88,P值均<0.05);而THFA,FRα 2组间差异均无统计学意义(P值均>0.05).结论 ASD患者体内存在明显的叶酸代谢异常,叶酸、维生素B12、5-MTHF水平降低,而Hcy、FRAA含量升高.ASD患者叶酸代谢异常可能成为ASD的预警信号,应及时开展靶向营养干预.     

孤独症谱系障碍儿童体成分病例对照研究

探讨ASD儿童与正常体重儿童的体成分差异和肥胖状况,为开展ASD儿童的综合干预提供依据.方法 应用Inbody J 30体成分测试仪,对48例ASD儿童和按年龄—性别匹配的48名正常儿童的身高、体重、体脂含量、身体总水分、蛋白质、无机盐、骨骼肌等体成分指标进行测量,并联合应用体质量指数(BMI)、体脂率(PBF)、腰围(WC)3种评价标准评定ASD儿童和正常儿童的肥胖状况.结果 ASD儿童的身体总水分、蛋白质、体脂量、去脂体重等含量以及PBF,BMI指标均明显高于正常儿童,差异均有统计学意义(t值分别为2.67,3.11,2.84,2.69,2.05,3.49,P值均<0.05);按BMI,PBF,WC评价标准,ASD儿童肥胖检出率均明显高于正常儿童,差异均有统计学意义(x2值分别为6.071,6.026,5.978,P值均<0.05).结论 ASD儿童与正常儿童的体成分和肥胖检出率存在差异.在针对ASD儿童进行康复教育训练的同时,应加强膳食行为指导、开展综合干预.     

孤独症谱系障碍儿童父母性格特征和家庭环境的病例对照研究

探讨孤独症谱系障碍(ASD)儿童父母性格特征和家庭环境特点及其与儿童孤独症谱系障碍发病的关系,为预防由于父母性格问题导致的孤独症儿童养育环境不良因素发生提供参考.方法 应用家庭环境量表中文版(FES-CV)和成人版艾森克人格问卷(EPQ)对79例孤独症谱系障碍患儿和79例正常儿童的父母进行对照研究.结果 ASD组儿童父亲掩饰程度、母亲内外向、家庭亲密度、情感表达、知识性、娱乐性、道德宗教观、组织性和控制性得分均低于正常组(t值分别为-2.95,-2.33,-2.50,-3.15,-3.41,-3.15,-3.92,-3.42,P值均<0.05);病例组儿童家庭矛盾性、父亲神经质和母亲神经质得分高于正常组(t值分别为-2.50,2.29,2.23,P值均<0.05).回归分析显示,家庭矛盾性、知识性、组织性、控制性、父亲掩饰程度、母亲内外向是孤独症谱系障碍发病的影响因素(P值均<0.05).结论 孤独症谱系障碍患儿父母性格偏离,家庭环境不良,且与患儿发病有关.应重视父母的心理健康及家庭环境的调整.     

孤独症谱系障碍患儿25羟维生素D水平及其与临床特征的相关性

目的研究孤独症谱系障碍(ASD)患儿25羟维生素D水平[25(OH) D]特点及其与临床特征的相关性,为孤独症谱系障碍的病因研究提供数据支撑。方法收集2017年1月至2019年1月期间武汉市优抚医院门诊及住院康复训练的ASD患儿196例为ASD组,同时收集同期来院就诊的健康儿童178例为健康对照组,比较两组25(OH) D水平及一般资料的差异。根据25(OH) D水平(≥30 ng/m L)将ASD组分为25(OH) D正常组与异常组,比较两组一般资料、儿童孤独症评定量表(CARS)总分及各因子分的差异,评估ASD患儿血清25(OH) D水平与CARS总分及各因子分的相关性。结果ASD组25(OH) D水平低于健康对照组(P<0.01),ASD患儿中睡眠障碍、偏食、呕吐、便秘、腹泻的报告率与健康儿童相比差异有统计学意义(P值均<0.01); 25(OH) D正常组与异常组在母乳喂养、睡眠障碍、偏食、腹泻报告率差异有统计学意义(χ2值分别为4.97,8.69,6.67,3.98,P值均<0.05),在CARS总分、人际关系、模仿、情感反应、躯体运用能力、与非生命物体的关...     

孤独症谱系障碍儿童及模型鼠痛觉敏感特征

目的 探讨孤独症谱系障碍(autism spectrum disorder,ASD)儿童及模型鼠痛觉敏感特征,为ASD临床综合干预提供思路.方法 采用病例-对照研究方法,应用孤独症治疗评估量表(ATEC)中与痛觉敏感性相关的条目,对哈尔滨市142名ASD儿童和142名正常儿童的疼痛敏感特征进行调查.动物学实验选用2种公...     

孤独症谱系障碍儿童触觉异常特征与临床症状的关联

目的 探索孤独症谱系障碍(ASD)儿童是否存在明显的触觉异常以及触觉异常与孤独症临床症状之间的相关性,为孤独症触觉异常的干预治疗提供科学依据.方法 收集在黑龙江省孤独症定点康复机构接受康复训练的265例3.02～10.66岁ASD儿童作为病例组,并依据性别年龄匹配原则,在哈尔滨市幼儿园和小学招募223名3.15～ 10...     

孤独症谱系障碍儿童运动功能缺陷研究

<正>孤独症谱系障碍(autism spectrum disorder,ASD)是一组神经发育障碍性疾病^[1],核心症状包括两大方面:社交沟通障碍,狭隘、重复的兴趣或行为^[2]。ASD儿童的父母和临床医生常述ASD儿童运动水平低于同龄的典型发育(typical development,TD)儿童,主要表现为运动发育迟滞、姿势平衡障碍及异常运动模式^[3-6]。Ouellette-kuntz等^[4,7]分别报告了59%和79%ASD儿童存在运动功能缺陷,且进一步影响了他们的社交和日常生活。未经干预训练的ASD儿童运动功能缺陷可以持续至成年后,影响一生发展^[8]。     

癫痫儿童合并孤独症相关危险因素及早期征象的病例对照研究

目的探讨癫痈儿童合并孤独症的相关危险因因素及该症的早期征象。方法对本院43例癫痫伴孤独症患儿（A组）与50例不伴孤独症的癫痫患儿（B组）进行对照研究，分析癫痈儿童合并孤独症的相关危险因素及早期临床表现。结果癫痈合并孤独症患儿较一般癫痫患儿的相关危险因素增多，孤独症早期表现明显，大多数癫痫伴孤独症患儿的父母在2岁前就发现自己的孩子与同龄儿童有明显不同。结论多种因素与癫痈儿童合并孤独症相关。加强儿童保健，减少围产期及发育期存在的一些相关危险因素，可能减少孤独症的伴发。强调对癫痫合并孤独症患儿的早期诊断，并尽早进行干预治疗以改善其预后。     

神经免疫指标与孤独症谱系障碍的关联

探讨骨桥蛋白(osteopontin,OPN)、白介素17A(interleukin-17A,IL-17A)、抗髓鞘碱性蛋白抗体(anti-MBP auto-antibody)与孤独症谱系障碍(autism spectrum disorder,ASD)的关系,为ASD的病因及发病机制研究提供理论依据.方法 采用病例对照研究方法,收集哈尔滨市孤独症康复定点机构进行康复训练的ASD儿童40例作为病例组,1:1性别、年龄匹配的正常儿童作为对照组.应用酶联免疫吸附试验(ELISA)方法检测两组儿童血清OPN,IL-17A,anti-MBP auto-antibody水平,并采用Pearson或Spearman相关与ASD儿童严重程度及智力水平进行关联分析.结果 ASD组血清OPN,IL-17A水平[(296.89±162.95),0.93]pg/mL均高于对照组[(217.98±113.39),0.62]pg/mL(P值均<0.05).ASD组血清OPN,IL-17A,anti-MBP auto-antibody水平与儿童孤独症行为量表(ABC),儿童孤独症评定量表(CARS),皮博迪图片词汇测验(PPVT)得分相关均无统计学意义(P值均>0.05),ASD组血清anti-MBP auto-antibody与OPN,IL-17A均呈正相关(r值分别为0.35,0.34,P值均<0.05).结论 ASD儿童存在明显的神经免疫异常,机制有待进一步探讨.     

孤独症谱系障碍儿童左侧视野优势效应研究

目的 探索孤独症谱系障碍儿童对面孔加工中左侧视野优势效应的损害情况,为加深理解孤独症社交损害的注意机制提供依据.方法 采取重复测量资料的混合设计,招募2016年9月—2019年12月在天津市各个孤独症康复机构训练的105名孤独症儿童,组成病例组,按照病例组的年龄和性别匹配正常发育的天津市小学或幼儿园就读的105名正常儿...     

Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency: a systematic review of randomized controlled trials

BACKGROUND: Vitamin B(12) deficiency is common, increasing with age. Most people are treated in primary care with intramuscular vitamin B(12). Several studies have reported equal efficacy of oral administration of vitamin B(12). OBJECTIVES: We set out to identify randomized controlled trial (RCT) evidence for the effectiveness of oral versus intramuscular vitamin B(12) to treat vitamin B(12) deficiency. METHODS: We conducted a systematic review searching databases for relevant RCTs. Outcomes included levels of serum vitamin B(12), total serum homocysteine and methylmalonic acid, haemoglobin and signs and symptoms of vitamin B(12) deficiency. RESULTS: Two RCTs comparing oral with intramuscular administration of vitamin B(12) met our inclusion criteria. The trials recruited a total of 108 participants and followed up 93 of these from 90 days to 4 months. In one of the studies, mean serum vitamin B(12) levels were significantly higher in the oral (643 +/- 328 pg/ml; n = 18) compared with the intramuscular group (306 +/- 118 pg/ml; n = 15) at 2 months (P < 0.001) and 4 months (1005 +/- 595 versus 325 +/- 165 pg/ml; P < 0.0005) and both groups had neurological responses. In the other study, serum vitamin B(12) levels increased significantly in those receiving oral vitamin B(12) and intramuscular vitamin B(12) (P < 0.001). CONCLUSIONS: The evidence derived from these limited studies suggests that 2000 microg doses of oral vitamin B(12) daily and 1000 microg doses initially daily and thereafter weekly and then monthly may be as effective as intramuscular administration in obtaining short-term haematological and neurological responses in vitamin B(12)-deficient patients.     

Low folate and vitamin B12 nourishment is common in Omani children with newly diagnosed autism

ObjectiveArab populations lack data related to nutritional assessment in children with autism spectrum disorders (ASDs), especially micronutrient deficiencies such as folate and vitamin B12.MethodsTo assess the dietary and serum folate and vitamin B12 statuses, a hospital-based case–control study was conducted in 80 Omani children (40 children with ASDs versus 40 controls).ResultsThe ASD cases showed significantly lower levels of folate, vitamin B12, and related parameters in dietary intake and serum levels.ConclusionThese data showed that Omani children with ASDs exhibit significant deficiencies in folate and vitamin B12 and call for increasing efforts to ensure sufficient intakes of essential nutrients by children with ASDs to minimize or reverse any ongoing impact of nutrient deficiencies.     

Tissue distribution of oral vitamin B12 is influenced by B12 status and B12 form: an experimental study in rats

Purpose

Hydroxocobalamin (HOCbl) is the dominating Cbl form in food, whereas cyanocobalamin (CNCbl) is common in vitamin pills and oral supplements. This study compares single-dose absorption and distribution of oral HO[⁵⁷Co]Cbl and CN[⁵⁷Co]Cbl in Cbl-deficient and normal rats.

Methods

Male Wistar rats (7 weeks) were fed a 14-day diet with (n?=?15) or without (n?=?15) Cbl. We compared the uptakes of HO[⁵⁷Co]Cbl (free or bound to bovine transcobalamin) and free CN[⁵⁷Co]Cbl administered by gastric gavage (n?=?5 in each diet group). Rats were sacrificed after 24 h. Blood, liver, kidney, brain, heart, spleen, intestines, skeletal muscle, 24-h urine and faeces were collected, and the content of [⁵⁷Co]Cbl was measured. Endogenous Cbl in tissues and plasma was analysed by routine methods.

Results

Mean endogenous plasma-Cbl was sevenfold lower in deficient vs. normal rats (190 vs. 1330 pmol/L, p?<?0.0001). Cbl depletion increased endogenous Cbl ratios (tissue/plasma?=?k_in/k_out) in all organs except for the kidney, where the ratio decreased considerably. Twenty-four-hour accumulation of labelled Cbl showed that HOCbl?>?CNCbl (liver) and CNCbl?>?HOCbl (brain, muscle and plasma).

Conclusions

The Cbl status of rats and the administered Cbl form influence 24-h Cbl accumulation in tissues and plasma.

     

Bioavailability of vitamin B12

Vitamin B12 deficiency is common in people of all ages who consume a low intake of animal-source foods, including populations in developing countries. It is also prevalent among the elderly, even in wealthier countries, due to their malabsorption of B12 from food. Several methods have been applied to diagnose vitamin B12 malabsorption, including Schilling?s test, which is now used rarely, but these do not quantify percent bioavailability. Most of the information on B12 bioavailability from foods was collected 40 to 50 years ago, using radioactive isotopes of cobalt to label the corrinoid ring. The data are sparse, and the level of radioactivity required for in vivo labeling of animal tissues can be prohibitive. A newer method under development uses a low dose of radioactivity as (14)C-labeled B12, with measurement of the isotope excreted in urine and feces by accelerator mass spectrometry. This test has revealed that the unabsorbed vitamin is degraded in the intestine. The percent bioavailability is inversely proportional to the dose consumed due to saturation of the active absorption process, even within the range of usual intake from foods. This has important implications for the assessment and interpretation of bioavailability values, setting dietary requirements, and interpreting relationships between intake and status of the vitamin.