| 应琴,黄清选,张剑英.注意缺陷多动障碍患儿血清25（OH）D及微量元素表达水平及临床意义[J].浙江中西医结合杂志,2022,32(1): |
| 注意缺陷多动障碍患儿血清25（OH）D及微量元素表达水平及临床意义 |
| Expression and clinical significance of serum 25 (OH) D and trace elements in children with attention deficit hyperactivity disorder |
| 投稿时间：2021-03-09 修订日期：2021-11-16 |
| DOI： |
| 中文关键词: 注意缺陷多动障碍 25羟基维生素D 微量元素 临床意义 |
| 英文关键词:attention deficit hyperactivity disorder 25-hydroxyvitamin D trace elements clinical significance |
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| 中文摘要: |
| 目的 探究注意缺陷多动障碍(ADHD)患儿血清25羟基维生素D[25(OH)D]、微量元素表达水平及临床意义。方法 选取2019年4月至2020年11月本院诊治的84例ADHD患儿进行研究(ADHD组),依据ADHD分型标准将患儿分为注意缺陷为主型组(28例)、多动为主型组(33例)、混合型组(23例),并选取同期84例体检健康儿童进行对照研究(对照组)。采用高效液相色谱-串联质谱法检测所有受试儿童血清25(OH)D水平；检测血清铁(Fe)、磷(P)、镁(Mg)、钙(Ca)、铜(Cu)、锌(Zn)、铅(Pb)水平；Pearson法分析ADHD患儿血清25(OH)D水平与Cu、Zn、Pb水平的相关性；Logistic回归分析ADHD发生的影响因素；受试者工作特征(ROC)曲线分析血清25(OH)D、Zn、Pb水平对ADHD的诊断价值。结果 ADHD组血清25(OH)D、Cu、Zn水平均显著低于对照组(P<0.05),Pb水平显著高于对照组(P<0.05)；注意缺陷为主型组、多动为主型组、混合型组患儿血清25(OH)D、Fe、P、Mg、Ca、Cu、Zn、Pb水平比较,差异无统计学意义(P>0.05)；ADHD患儿血清25(OH)D水平与Cu、Zn水平均呈正相关(P<0.05),与Pb水平呈负相关(P<0.05)；25(OH)D、Zn是影响ADHD发生的保护因素(P＜0.05),Pb是影响ADHD发生的危险因素(P＜0.05)；血清25(OH)D、Zn、Pb水平诊断ADHD的曲线下面积(AUC)分别为0.773、0.770、0.772,截断值分别为21.01 ng/mL、16.05 μmol/L、50.69 μg/L,相应灵敏度分别为82.1%、77.4%、63.1%,特异度分别为67.9%、71.4%、88.1%；三者联合诊断ADHD的AUC为0.883,其灵敏度、特异度分别为81.0%、81.0%。结论 ADHD患儿血清25(OH)D、Cu、Zn水平降低,Pb水平升高,25(OH)D、微量元素水平与ADHD患儿类型无关,25(OH)D、Zn、Pb联合有助于临床筛查ADHD患儿。 |
| 英文摘要: |
| Objective To explore the expression level of 25-hydroxyvitamin D [25 (OH) D] and trace elements in children with attention deficit hyperactivity disorder (ADHD) and its clinical significance. Methods A total of 84 cases of ADHD children diagnosed and treated in our hospital from April 2019 to November 2020 were selected for the study (ADHD group), and according to the ADHD classification criteria, the children were divided into the attention deficit type group (28 cases), hyperactivity type group (33 cases) and mixed type group (23 cases), and another 84 healthy children in the same period were selected for the control study (control group). The level of serum 25(OH)D was detected by High performance liquid chromatography tandem mass spectrometry; the levels of iron (Fe), phosphorus (P), magnesium (Mg), calcium (Ca), copper (Cu) , zinc (Zn) and lead (Pb) in serum were detected; Pearson method was used to analyze the correlation between serum 25(OH)D level and Cu, Zn, Pb levels in children with ADHD; Logistic regression analysis of the influencing factors of ADHD; in addition, receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of serum 25(OH)D, Zn, Pb levels for ADHD. Results The levels of serum 25(OH)D, Cu, Zn in ADHD group were significantly lower than those in control group (P < 0.05), and the level of Pb level was significantly higher than that in control group (P < 0.05); there was no significant difference in serum 25(OH)D, Fe, P, Mg, Ca, Cu, Zn, Pb levels between the attention deficit type group, hyperactivity type group and mixed type group (P > 0.05); serum 25(OH)D level was positively correlated with Cu and Zn levels (P < 0.05), but negatively correlated with Pb level (P < 0.05); 25(OH)D and Zn were the protective factors of ADHD (P < 0.05), and Pb was the risk factor of ADHD (P < 0.05); the area under the curve (AUC) of serum 25(OH)D, Zn and Pb levels in the diagnosis of ADHD were 0.773, 0.770 and 0.772 respectively, the cut-off values were 21.01 ng/mL, 16.05 μmol/L and 50.69 μg/L, respectively, the corresponding sensitivity was 82.1%, 77.4%, 63.1%, and the specificity was 67.9%, 71.4%, 88.1%, respectively; the AUC of combined diagnosis for ADHD was 0.883, and the sensitivity and specificity were 81.0% and 81.0%, respectively. Conclusions The levels of serum 25(OH)D and Cu and Zn are decreased, and the level of Pb is increased, the levels of vitamin D and trace elements are not related to the type of children with ADHD, in addition, the combination of 25(OH)D, Zn and Pb is helpful for clinical screening of ADHD children. |
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