Abstract: Objective To explore the association of vitamin D(VD) level with tic disorder (TD) symptom severity and clinical classification, in order to provide evidence for comprehensive diagnosis and treatment of TD. Methods From March 2020 to November 2020, a total of 225 TD children (TD group) and 228 healthy children (control group) in Shanghai Children's Medical Center, Affiliated to Shanghai Jiao Tong University School of Medicine, were retrospectively enrolled in this study. According to the Yale Global Tic Severity Scale (YGTSS), children in the TD group were divided into mild TD group (≤25 points)and moderate to severe TD group(＞25 points). According to the DSM-Ⅴ clinical classification standard, children with TD were divided into provisional tic disorder group (PTD group), chronic tic disorder group (CTD group) and Tourette syndrome group (TS group). The correlation between vitamin D deficiency and the development of TD was analyzed. Results Serum VD level of children in TD group was significantly lower than that of the control group[(22.18±6.29) ng/ml,(26.14±6.48) ng/ml, t=6.60,P<0.001], and the proportion of insufficient or lacking VD (89.8%) was high in the control group (75.9%) (χ²=15.35, P<0.001). Serum VD level of the moderate to severe TD group was lower than that of the mild TD group and the control group (F=23.85, P<0.001). Serum VD level of TD children was negatively related to the severity of symptoms (r=-0.215, P=0.001). The difference in VD levels among three clinical subtypes of TD and the control group was statistically significant (F=16.93, P<0.001). Among them, the CTD group had the lowest VD level, which was significantly lower than the control group.The proportion of insufficient or lack of serum VDin children with TD subtypeswas higher than that of the control group (χ²=15.91, P<0.001). Conclusions VD deficiency is more common in children with TD. There is a certain correlation between the degree of VD deficiency and the severity of tic disorder symptoms and clinical subtypesin children with TD. The detection of vitamin D level can be used as an auxiliary examination for children with TD, providing new clinical ideas for the treatment of TD.

Key words: tic disorder, vitamin D, children, clinical subtypes, severity

摘要： 目的 分析维生素D(VD)与抽动障碍(TD)症状严重程度、临床分型的关系,为TD综合诊治提供临床依据。方法 对2020年3—11月就诊于上海交通大学医学院附属上海儿童医学中心专科门诊的225例TD患儿(TD组)和228例健康体检儿童(对照组)进行回顾性分析,根据耶鲁综合抽动严重程度量表(YGTSS),TD组儿童分为轻度TD组(≤25分)和中重度TD组(＞25分),根据DSM-5临床分型标准,将TD儿童分为一过性抽动障碍(PTD)组、慢性抽动障碍(CTD)组和Tourette综合征(TS)组。分析维生素D缺乏与TD发生发展的相关性。结果 TD组VD水平显著低于对照组[(22.18±6.29)ng/ml,(26.14±6.48)ng/ml,t=6.60,P<0.001],VD不足或缺乏比例(89.8%)显著高于对照组(75.9%),差异有统计学意义(χ²=15.35,P<0.001)。中重度TD组VD水平低于轻度TD组和对照组(F=23.85,P＜0.001)。TD儿童VD水平与症状严重程度呈负相关(r=-0.215,P=0.001)。TD的三组临床亚型与对照组VD水平差异有统计学意义(F=16.93,P<0.001),其中,CTD组VD水平最低,其含量显著低于对照组,各亚型TD儿童血清VD含量不足或缺乏的比例高于对照组(χ²=15.91,P<0.001)。 结论 VD缺乏在TD患儿中比较普遍。TD儿童VD缺乏程度与TD症状严重程度、临床亚型存在一定相关性。维生素D水平的检测可为TD的辅助治疗提供新的临床思路。

关键词: 抽动障碍, 维生素D, 儿童, 临床亚型, 严重程度