The Level Of Fat-soluble Vitamins In Blood Of Children With Tic Disorder And Its Clinical Significance

Objectives To explore the levels of vitamin A(VA),vitamin D(VD)and vitamin E(VE)in the blood of children with tic disorders(TD),and their association with clinical types of TD,severity of tic symptoms and co-morbidity of TD,so as to provide evidence for better prevention and treatment of TD.Methods 1.A total of 245 children with TD from September 2018 to April 2019 in the Department of Child Health care,Affiliated Hospital of Qingdao University were enrolled while the case group and 63 healthy children who underwent routine physical examination at the same time as the control group.2.The children in the case group were assessed for severity and co-morbidities by The Yale Global Tic Severity Scale(YGTSS),Conners Parent Symptom Questionnaire(PSQ),the children ' s Yale-Brown Obsessive-Compulsive Scale(CY-BOCS).Meanwhile,the two groups of children's direct dependents(guardians),including the case group and the control group,filled in the tic disorder influencing factors questionnaire(self-made)to understand the basic information of children and their family situation.3.The levels of serum VA and VE were determined by High-Performance-Liquid-Chromatographie(HPLC),and the serum VD [25(OH)D]levels were determined by High performance liquid chromatography-tandem mass spectrometry(HPLC-MS/MS)to assess the fat-soluble vitamin levels of the two groups.4.Data were expressed as mean±standard deviation(SD).the comparison of two groups of means were analyzed using independent T-test;comparisons of multiple groups of means were analyzed using one-way analysis of variance(ANOVA),followed by snk-q test to estimate the significance of difference.Meanwhile,the count data is expressed by percentage(%);the comparisons in two groups or multiple groups were expressed by Chi-square test.All statistical analyses were performed using a Statistical Package for the Social Sciences(SPSS)version 22.Results 1.There was no significant difference in the birth condition,family structure,parental culture level,the age at which the parents gave birth to the child and other family history of mental illness in the case group and the control group.The number of family tic history in the case group was significantly higher than that in the healthy control group(?~2=8.15,P=0.004).2.The VD level of the case group was significantly lower than that of the control group(23.72 ± 8.87ng/m L vs 26.61 ± 7.59ng/m L;t=-2.24,P=0.03),and the proportion of deficiency or even lack(37.31%,75/201)was higher than the control group(15.79%,9/57)(?~2=9.37,P=0.002).3.According to the YGTSS results,the children in the case group were divided into mild,moderate and severe severity.(1)There were significant differences in serum VA and VD levels between the case group(mild TD group,moderate-to-severe TD group)and the control group(F=29.79,P=0.000;F=10.90,P=0.000).Among them,the content of VA and VD in moderate-to-severe TD group were lower than those in mild TD group and control group [VA:(0.29±0.06 mg/L)vs(0.35±0.06 mg/L,0.34±0.06 mg/L);VD:(21.01±8.30 ng/m L)vs(25.84±8.76 ng/m L,26.61±7.59 ng/m L)].(2)Spearman's correlation coefficients was used to analyze the correlation between the serum VA,VD and VE levels and severity scores of tic symptoms in the case group.There was a negative correlation between VA and VD levels and severity of children with TD(r=-0.325,P=0.001;r=-0.228,P=0.001).(3)There was no correlation between serum VE level and the severity of TD tic symptoms(r=-0.068,P=0.287).4.According to DSM-V classification criteria,children with TD were classified clinically(PTD group,CTD group,TS group).(1)The serum levels of VA and VE is not significant different with the clinical types.(F=0.87,P=0.46;F=1.14,P = 0.34).(2)The levels of serum VD were different among the four groups(F=4.13,P=0.007).Among them,the VD level in TS group was the lowest,and its content was significantly lower than that in control group(21.83±7.60 ng/ml vs 26.61±7.59 ng/ml,P<0.05).There were no significant difference between PTD group,CTD group and control group(P=0.35).The prevalence of insufficient or even lack of serum VD in children with different subtypes of TD was higher than that in the control group(?~2=10.88,P=0.01).5.There was no significant difference in fat-soluble vitamins levels among TD-only children,children with TD combined with ADHD,OCD,ADHD and OCD.Conclusion 1.Vitamin D deficiency exists in children with TD.2.There is a negative correlation between the VA and VD levels in the blood of TD children and the severity of tic symptoms.3.The VD level is related to clinical type.4.The level of fat-soluble vitamins in children with TD is not related to the co-morbidity of TD.