抽动障碍儿童血清锌、铁、铅、铜、镁、钙含量的Meta分析

doi:10.11852/zgetbjzz2020-1969

摘要/Abstract

摘要： 目的探究抽动障碍儿童血清微量元素含量与正常健康儿童的差异,为抽动障碍的防治提供参考。方法检索中国知网数据库(CNKI)、重庆维普中文科技期刊数据库(VIP)、万方数据库(Wanfang Data)、临床试验注册中心、Pubmed、Embase、Cochrane Library及Web of Science等数据库,检索词包括抽动障碍、微量元素、血铅、血锌、血铁等,收集检测抽动障碍患儿血清锌、铁、铅、铜、镁、钙等元素数值的病例-对照研究,运用RevMan 5.3及Stata15进行Meta分析。结果最终纳入中英文文献共19篇,时间跨度为15年,纳入抽动障碍患儿共3 762例,对照组健康儿童共4 800例。Meta分析结果显示:相比于正常健康儿童,抽动障碍患儿的血铅水平更高(MD=23.75,95%CI:13.57~33.92, P＜0.001),血铁(MD=-62.64,95%CI:-84.35~-40.93, P＜0.001)、锌(MD=-0.87, 95%CI:-1.19~-0.55, P＜0.001)水平偏低,而血镁、血钙与血铜水平差异无统计学意义。Logistic回归分析显示,血铅、锌、铁的异常与抽动障碍的发病相关。结论抽动障碍患儿血清铅偏高而血清锌、铁偏低,且血清铅、锌、铁的异常可能与抽动障碍的发病相关。

关键词: 抽动障碍, 微量元素, 血锌, 血铁, 血铅, 血铜, 血镁, 血钙, Meta分析

Abstract: Objective To explore the difference of serum trace elements between children with tic disorder (TD) and healthy children, in order to provide reference for the prevention and treatment of TD. Methods CNKI,VIP, Wanfang, Clinical Trial Registration Center, Pubmed, Embase, Web of Science and Cochrane Library were searched to retrieve case-control studies where serum levels of zinc, iron, lead, copper, magnesium, calcium and other elements in TD children were tested.Keywords included tic disorder/TD, trace elements, blood lead, blood zinc, blood iron, etc.RevMan 5.3 and Stata 15 were used to conduct Meta-analysis. Results A total of 19 articles in Chinese and English were finally included, with a time span of 15 years.Totally 3 762 TD children and 4 800 healthy children in the control group were included.Meta-analysis results showed that compared with healthy children, TD children had higher serum level of lead (MD=23.75, 95%CI:13.57 - 33.92, P＜0.001), lower serum levels of iron (MD=-62.64, 95%CI:-84.35 - -40.93, P＜0.001) and zinc (MD=-0.87, 95%CI:-1.19 - -0.55, P＜0.001),but no significant difference was found in serum magnesium, calcium and copper(P＞0.05).Logistic regression analysis showed that the abnormality of serum lead, zinc and iron was related to tic disorder. Conclusions Children with TD have higher level of serum lead and lower level of serum zinc and iron.And the abnormality of serum lead, zinc and iron may be related to the pathogenesis of tic disorder.

Key words: tic disorder, trace elements, zinc, iron, lead, copper, magnesium, calcium, Meta-analysis

中图分类号:

R749.94

李维峰, 王子杨, 徐梦君, 韩新民. 抽动障碍儿童血清锌、铁、铅、铜、镁、钙含量的Meta分析[J]. 中国儿童保健杂志, 2022, 30(4): 422-426.

LI Wei-feng, WANG Zi-yang, XU Meng-jun, HAN Xin-min. Meta-analysis of serum zinc, iron, lead, copper, magnesium and calcium in children with tic disorder[J]. Chinese Journal of Child Health Care, 2022, 30(4): 422-426.

参考文献

[1] 刘永翼,郑毅,韩书文,等.北京市大兴区6～16岁中小学生抽动障碍的现况调查[J].中华精神科杂志,2009,42(4):231-234.
[2] 刘玲,江志贵,李微,等.顺德龙江地区小学生抽动障碍流行病学调查及其与微量元素的关系[J].中国当代儿科杂志,2013,15(8):657-660.
[3] 郑荣远,金嵘,徐惠琴,等.温州地区7～16岁中小学生抽动障碍的现况调查[J].中华流行病学杂志,2004,25(9):17-19.
[4] 冷丽梅,衣明纪,张柱海.莱阳市城乡4～16岁儿童抽动障碍现状调查[J].社区医学杂志,2012,10(7):3-6.
[5] 刘智胜, 儿童抽动障碍[M].北京:人民卫生出版社,2015.
[6] 刘智胜,秦炯,蔡方成,等.儿童抽动障碍的诊断与治疗建议[J].中华儿科杂志,2013,51(1):72-75.
[7] Li Y,Hasenhuetl PS,Schicker K,et al.Dual action of Zn²⁺ on the transport cycle of the dopamine transporter.[J].Biol Chemi,2015,290(52):31069-31076.
[8] Khan FH, Ahlberg CD, Chow CA, et al.Iron, dopamine, genetics, and hormones in the pathophysiology of restless legs syndrome[J].J Neurol,2017, 264(8):1634-1641.
[9] 黄啸君,曹立.脑组织铁沉积性神经变性病遗传学研究进展[J].中国现代神经疾病杂志,2017,17(7):490-499.
[10] 邓月,李赵聪,朱晓娟,等.铅体外神经毒性的研究进展[J].现代预防医学,2020,47(16):3015-3018.
[11] 董崇娟,李永辉,王永强, 等.抽动障碍患儿血铅及微量元素含量的变化[J].心理医生,2015,21(21):35-35,36.
[12] 蒋玉红,牟文凤,王亚秋, 等.抽动症患儿体内铅含量对T细胞活性的影响[J].中国实验诊断学,2008,12(6):774-776.
[13] 胡利军.多发性抽动症患儿的微量元素水平与中医证型相关性的临床研究[D].北京:北京中医药大学,2009.
[14] 赵小芳.多发性抽动症患儿血清微量元素水平检测结果分析[J].浙江临床医学,2015,17(10):1793-1794.
[15] 刘勇,田广燕,梁向荣, 等.儿童血铅水平对抽动障碍的影响[J].现代中西医结合杂志,2012,21(20):2199-2200.
[16] 刘玲,江志贵,李微, 等.顺德龙江地区小学生抽动障碍流行病学调查及其与微量元素的关系[J].中国当代儿科杂志,2013,15(8):657-660.
[17] 赵艳艳.血铅及其它微量元素的变化对抽动障碍患儿的影响[D].济南:山东大学,2017.
[18] 崔圣涛.小儿抽动症与微量元素及维生素A/D/E的相关性研究[D].长春:长春中医药大学,2017.
[19] 祝雪英,郁峰,毛春发.血铅、锌水平与儿童抽动障碍的相关性分析[J].中国基层医药,2018,25(7):850-853.
[20] 黄柏青,高瑛瑛,郑艺霞, 等.血铅水平与儿童行为问题关系探讨[J].中国妇幼保健,2009,24(1):70-71.
[21] 焦鹏涛,陈彦明,朱安国.195例抽动障碍儿童铅锌含量分析[J].宁夏医学杂志,2006,28(9):701-702.
[22] 张爱启,田执梁,计玲玲, 等.抽动障碍患儿血清脑源性神经营养因子及微量元素锌水平检测及临床意义[J].现代生物医学进展,2009,9(17):3275-3276,3284.
[23] 黄永生,廖柳华.抽动障碍与微量元素锌的相关性探讨[J].现代临床医学,2016,42(3):198-199.
[24] 宋锦.抽动障碍与微量元素锌关系临床研究[J].微量元素与健康研究,2013,30(5):12.
[25] 阮洋,莫丽亚,张聪,等.儿童抽动症与微量元素水平的相关性研究[J].国际检验医学杂志,2014,35(19):2691-2692.
[26] 伊长英,范美丽,任广芳, 等.332例抽动障碍儿童全血锌含量的测定及临床意义[J].中国保健营养,2016,26(11):125-125,126.
[27] Qian RY, Ma Y, You LQ, et al.The blood levels of trace elements are lower in children with tic disorder:Results from a retrospective study[J].Front Neurol,2019, 10:1324.
[28] 李小萍,闫承生,李杏色,等.抽动障碍患儿血液中铁、锌和铅含量分析[J].河北医药,2014,36(17):2639-2640.
[29] 王景刚,白莉,魏洪妍,等.多发性抽动症患儿血清钙、铁、锌水平检测结果分析[J].中国现代医生,2012,50(28):61,64.
[30] 周彤,周志俊.铅单独及与其他重金属联合暴露对儿童神经发育的影响[C]//上海市预防医学会《环境与职业医学》编辑部复旦大学,第十三届全国环境与职业医学研究生学术研讨会论文集,2017:103-107.
[31] 蔚立涛,关明杰.低水平铅暴露对儿童神经损伤作用及机制的研究进展[J].包头医学院学报,2020,36(5):117-120.
[32] 尹镜雯,高晶,苏红,等.醋酸铅与纳米硫化铅经口染毒对仔鼠海马中氨基酸类神经递质的影响[J].毒理学杂志,2015,29(3):168-172.
[33] Ding L,Yang Z, Liu G, et al.Safety and efficacy of taurine as an add-on treatment for tics in youngsters[J].Eur J Neurol,2020, 27(3):490-497.
[34] 胡亚美,江载芳,申昆玲,等.诸福棠实用儿科学[M].8版.北京: 人民卫生出版社, 2015.
[35] Golub MS,Takeuchi PT,Keen CL,et al.Activity and attention in zinc deprived adolescent monkeys[J].Am J Clin Nutr,1996,18(3):908-915.
[36] Kim J, Wessling-Resnick M.Iron and mechanisms of emotional behavior[J].J Nutr Biochem,2014, 25(11):1101-1107.
[37] Ghosh D,Elizabeth B.Relationship of serum ferritin level and tic severity in children with Tourette syndrome[J].Childs Nerv Syst,2017,33(8):1373-1378.
[38] Isaev NK, Stelmashook EV,Genrikhs EE.Role of zinc and copper ions in the pathogenetic mechanisms of traumatic brain injury and Alzheimer's disease[J].Rev Neurosci,2020, 31(3):233-243.
[39] 方明娟,杨任民,吴君霞,等.铁代谢与神经变性性疾病[J/OL].中华临床医师杂志(电子版),2015,9(7):1201-1204.
[40] 陈玮玮,闫立成,曹孟颖,等.铅暴露对大鼠中枢神经系统铜和铁蓄积的影响[J].中华劳动卫生职业病杂志,2019,37(3):179-185.
[41] 曾泽吟,卫秦芝,黄广军.电子垃圾污染区铅镉暴露对学龄前儿童血液及神经系统的影响[J].中国保健营养,2017,27(3):275-276.