维生素D_3联合早期介入丹佛模式治疗幼儿孤独症谱系障碍的疗效
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摘要
目的探讨维生素D_3(VitD_3)联合早期介入丹佛模式(ESDM)对幼儿孤独症谱系障碍(ASD的疗效。方法选择102例1～3岁的ASD幼儿为研究对象。按家长意愿分为三组:常规康复组、ESDM组、ESDM+VitD_3组。各组幼儿治疗前及治疗3个月后进行ASD行为量表(ABC)、ASD评定量表(CARS)评估。结果常规康复组治疗3个月后ABC总分、躯体运动能区、生活自理能区分数均降低(P<0.05)。ESDM组治疗3个月后ABC总分、躯体运动能区、生活自理能区、交往能区、言语能区及CARS总分均降低(P<0.05)。ESDM+VitD_3组治疗3个月后25(OH)D水平明显升高,ABC总分、生活自理能区、感觉能区、交往能区、言语能区及CARS总分均降低(P<0.05)。ESDM组交往能区分数差显著高于常规康复组,ESDM+VitD_3组交往能区分数差高于其余两组(P<0.05)。结论 ESDM治疗可有效改善ASD幼儿的临床症状,特别针对交往能区相比常规康复疗效显著;ESDM联合VitD_3治疗对ASD幼儿交往能力改善更优,其可能是目前改善ASD幼儿临床症状的最佳方案之一。
Objective To study the clinical effect of vitamin D_3(VitD_3) combined with the Early Start Denver Model(ESDM) in the treatment of autism spectrum disorder(ASD) in toddlers. Methods A total of 102 toddlers with ASD, aged 1 to 3 years, were enrolled. According to the wishes of their parents, they were divided into conventional rehabilitation, ESDM and ESDM+VitD_3 groups. Autism Behavior Checklist(ABC) and Childhood Autism Rating Scale(CARS) were used evaluate behavior problems before treatment and after 3 months of treatment. Results The conventional rehabilitation group had significant reductions in the total score and the scores on somatic movement and self-care subscales of the ABC scale after 3 months of treatment(P<0.05). After 3 months of treatment, the ESDM group had significant reductions in the total score and the scores on somatic movement, self-care, social interaction and language subscales of the ABC scale(P<0.05), as well as a significant reduction in the total score of the CARS(P<0.05). After 3 months of treatment, the ESDM+VitD_3 group had a significant increase in the level of 25(OH)D and significant reductions in the total score and the scores on self-care, sensation, social interaction and language subscales of the ABC scale(P<0.05), as well as a significant reduction in the total score of the CARS(P<0.05). The ESDM group had a significantly greater reduction in the score on social interaction subscale than the conventional rehabilitation group(P<0.05). The ESDM+VitD_3 group had a significantly greater reduction in the score on social interaction subscale than the other two groups(P<0.05). Conclusions ESDM can effectively improve the clinical symptoms of toddlers with ASD, with a significantly better clinical effect in improving social interaction and somatic movement than conventional rehabilitation. ESDM combined with VitD_3 has a significantly better clinical effect in improving social communication skills and may be one of the best strategies for improving the clinical symptoms of toddlers with ASD.
Objective To study the clinical effect of vitamin D_3(VitD_3) combined with the Early Start Denver Model(ESDM) in the treatment of autism spectrum disorder(ASD) in toddlers. Methods A total of 102 toddlers with ASD, aged 1 to 3 years, were enrolled. According to the wishes of their parents, they were divided into conventional rehabilitation, ESDM and ESDM+VitD_3 groups. Autism Behavior Checklist(ABC) and Childhood Autism Rating Scale(CARS) were used evaluate behavior problems before treatment and after 3 months of treatment. Results The conventional rehabilitation group had significant reductions in the total score and the scores on somatic movement and self-care subscales of the ABC scale after 3 months of treatment(P<0.05). After 3 months of treatment, the ESDM group had significant reductions in the total score and the scores on somatic movement, self-care, social interaction and language subscales of the ABC scale(P<0.05), as well as a significant reduction in the total score of the CARS(P<0.05). After 3 months of treatment, the ESDM+VitD_3 group had a significant increase in the level of 25(OH)D and significant reductions in the total score and the scores on self-care, sensation, social interaction and language subscales of the ABC scale(P<0.05), as well as a significant reduction in the total score of the CARS(P<0.05). The ESDM group had a significantly greater reduction in the score on social interaction subscale than the conventional rehabilitation group(P<0.05). The ESDM+VitD_3 group had a significantly greater reduction in the score on social interaction subscale than the other two groups(P<0.05). Conclusions ESDM can effectively improve the clinical symptoms of toddlers with ASD, with a significantly better clinical effect in improving social interaction and somatic movement than conventional rehabilitation. ESDM combined with VitD_3 has a significantly better clinical effect in improving social communication skills and may be one of the best strategies for improving the clinical symptoms of toddlers with ASD.
引文
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[14]Vivanti G,Dissanayake C,Zierhut C,et al.Brief report:predictors of outcomes in the Early Start Denver Model delivered in a group setting[J].J Autism Dev Disord,2013,43(7):1717-1724.
[15]Estes A,Munson J,Rogers SJ,et al.Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder[J].J Am Acad Child Adolesc Psychiatry,2015,54(7):580-587.
[16]Mostafa GA,Al-Ayadhi LY.Reduced serum concentrations of 25-hydroxy vitamin D in children with autism:relation to autoimmunity[J].J Neuroinflammation,2012,9:201.
[17]Molloy CA,Kalkwarf HJ,Manning-Courtney P,et al.Plasma25(OH)D concentration in children with autism spectrum disorder[J].Dev Med Child Neurol,2012,52(10):969-971.
[18]Tostes MH,Polonini HC,Gattaz WF,et al.Low serum levels of 25-hydroxyvitamin D(25-OHD)in children with autism[J].Trends Psychiatry Psychother,2012,34(3):161-163.
[19]Neumeyer AM,Gates A,Ferrone C,et al.Bone density in peripubertal boys with autism spectrum disorders[J].J Autism Dev Disord,2013,43(7):1623-1629.
[20]Gong ZL,Luo CM,Wang L,et al.Serum 25-hydroxyvitamin D levels in Chinese children with autism spectrum disorders[J].Neuroreport,2014,25(1):23-27.
[21]杜琳,单玲,王冰,等.孤独症谱系障碍患儿血清25(OH)D水平的检测[J].中国当代儿科杂志,2015,17(1):68-71.
[2]Jia F,Wang B,Shan L,et al.Core symptoms of autism improved after vitamin D supplementation[J].Pediatrics,2015,135(1):e196-e198.
[3]Feng J,Shan L,Du L,et al.Clinical improvement following vitamin D3 supplementation in autism spectrum disorder[J].Nutr Neurosci,2017,20(5):284-290.
[4]Ko?ovskáE,Fernell E,Billstedt E,et al.Vitamin D and autism:clinical review[J].Res Dev Disabil,2012,33(5):1541-1550.
[5]Guillot X,Semerano L,Saidenberg-Kermanac'h N,et al.Vitamin D and inflammation[J].Joint Bone Spine,2010,77(6):552-557.
[6]Neve A,Corrado A,Cantatore FP.Immunomodulatory effects of vitamin D in peripheral blood monocyte-derived macrophages from patients with rheumatoid arthritis[J].Clin Exp Med,2014,14(3):275-283.
[7]Mostafa GA,Al-Ayadhi LY.The possible relationship between allergic manifestations and elevated serum levels of brain specific auto-antibodies in autistic children[J].J Neuroimmunol,2013,261(1-2):77-81.
[8]Patrick RP,Ames BN.Vitamin D hormone regulates serotonin synthesis.Part 1:relevance for autism[J].FASEB J,2014,28(6):2398-2413.
[9]Vivanti G,Dissanayake C,Duncan E,et al.Outcomes of children receiving Group-Early Start Denver Model in an inclusive versus autism-specific setting:a pilot randomized controlled trial[J].Autism,2018:1362361318801341.doi:10.1177/1362361318801341.[Epub ahead of print].
[10]徐秀.孤独症婴幼儿早期介入丹佛干预模式[J].中华实用儿科临床杂志,2015,30(11):801-802.
[11]美国精神医学学会.精神障碍诊断与统计手册(第五版)[M].张道龙,刘春宇,童慧琦,等,译.北京:北京大学出版社,2015:46-55.
[12]Cannell JJ,Hollis BW.Use of vitamin D in clinical practice[J].Altern Med Rev,2008,13(1):6-20.
[13]Dawson G,Rogers S,Munson J,et al.Randomized,controlled trial of an intervention for toddlers with autism:the Early Start Denver Model[J].Pediatrics,2009,125(1):e17-e23.
[14]Vivanti G,Dissanayake C,Zierhut C,et al.Brief report:predictors of outcomes in the Early Start Denver Model delivered in a group setting[J].J Autism Dev Disord,2013,43(7):1717-1724.
[15]Estes A,Munson J,Rogers SJ,et al.Long-term outcomes of early intervention in 6-year-old children with autism spectrum disorder[J].J Am Acad Child Adolesc Psychiatry,2015,54(7):580-587.
[16]Mostafa GA,Al-Ayadhi LY.Reduced serum concentrations of 25-hydroxy vitamin D in children with autism:relation to autoimmunity[J].J Neuroinflammation,2012,9:201.
[17]Molloy CA,Kalkwarf HJ,Manning-Courtney P,et al.Plasma25(OH)D concentration in children with autism spectrum disorder[J].Dev Med Child Neurol,2012,52(10):969-971.
[18]Tostes MH,Polonini HC,Gattaz WF,et al.Low serum levels of 25-hydroxyvitamin D(25-OHD)in children with autism[J].Trends Psychiatry Psychother,2012,34(3):161-163.
[19]Neumeyer AM,Gates A,Ferrone C,et al.Bone density in peripubertal boys with autism spectrum disorders[J].J Autism Dev Disord,2013,43(7):1623-1629.
[20]Gong ZL,Luo CM,Wang L,et al.Serum 25-hydroxyvitamin D levels in Chinese children with autism spectrum disorders[J].Neuroreport,2014,25(1):23-27.
[21]杜琳,单玲,王冰,等.孤独症谱系障碍患儿血清25(OH)D水平的检测[J].中国当代儿科杂志,2015,17(1):68-71.