25OH维生素D水平检测与自闭症评定量表（CARS）评分的相关性及预测模型研究

摘要 目的：探究25OH维生素D（25(OH) D）水平检测与自闭症评定量表（CARS）评分的相关性及其评估自闭症严重程度的价值。方法：选取2020年4月~2022年3月在我院确诊的自闭症谱系障碍（ASD）患儿67例作为ASD组，并按照病情严重程度将所有患儿分为轻中度组46例，重度组36例。另募集来我科就诊无精神病史及家族史的健康查体儿童93例作为对照组。对比ASD组与对照组、ASD患儿轻中度组与重度组25(OH) D水平差异，分析ASD组患儿25(OH)D水平的影响因素，比较ASD组不同25(OH)D水平患儿CARS评分差异性，分析ASD患儿血清25(OH)D水平与CARS评分的相关性，并采用ROC曲线评估血清25(OH)D水平预估ASD严重程度的效能。结果：ASD组患儿血清25(OH) D水平显著低于于对照组（P<0.05）。相较于轻中度组，重度孤独症组患儿血清25(OH) D水平显著降低（P<0.05）。25(OH) D异常组患儿中母乳喂养、偏食及腹泻发生率显著高于25(OH) D正常组（P<0.05）。25(OH) D异常组患儿中CARS评分中的人际关系、模仿、情感反应、肢体动作、使用物体、对变化的适应、视觉反应、听觉反应及总分显著高于25(OH) D正常组（P<0.05）。CARS总分分与血清25(OH)D水平的成负相关性（r=-0.367，P=0.004）。血清25(OH)D水平预估ASD严重程度的AUC为0.716，敏感度为72.48%，特异度为78.65%。结论：血清25(OH)D在ASD患儿中成低表达，而且不同严重程度患儿血清25(OH)D差异表达，而且血清25(OH)D水平与CARS总分成负相关性，其作为评估ASD严重程度的生物标志物具有一定价值。

Study on the Correlation and Prediction Model between 25oh Vitamin D Level and Autism Rating Scale (CARS)

ABSTRACT Objective: To explore the correlation between the level of 25oh vitamin D (25 (OH) d) and the score of Autism Rating Scale (cars) and its value in assessing the severity of autism. Methods: 67 children with autism spectrum disorder (ASD) diagnosed in our hospital from April 2020 to March 2022 were selected as ASD group, and all children were divided into mild to moderate group (46 cases) and severe group (36 cases) according to the severity of the disease. In addition, 93 healthy children without mental history and family history were recruited as the control group. To compare the difference of 25 (OH) d level between ASD group and control group, mild to moderate ASD group and severe ASD group, analyze the influencing factors of 25 (OH) d level of children in ASD group, compare the difference of cars score of children with different 25 (OH) d levels in ASD group, analyze the correlation between serum 25 (OH) d level and cars score of children with ASD, and evaluate the efficacy of serum 25 (OH) d level in predicting the severity of ASD by ROC curve. Results: The level of serum 25 (OH) d in ASD group was significantly lower than that in control group (P<0.05). The serum 25 (OH) d level in severe autism group was significantly lower than that in mild and moderate autism group (P<0.05). The incidence of breast feeding, partial feeding and diarrhea in 25 (OH) d abnormal group was significantly higher than that in 25 (OH) d normal group (P<0.05). In the 25 (OH) d abnormal group, the scores of interpersonal relationship, imitation, emotional response, limb movement, use of objects, adaptation to changes, visual response, auditory response and total scores in the cars score were significantly higher than those in the 25 (OH) d normal group (P<0.05). The total score of cars was negatively correlated with serum 25 (OH) d level (r=-0.367, P=0.004). The AUC of serum 25 (OH) d level to predict the severity of ASD was 0.716, the sensitivity was 72.48%, and the specificity was 78.65%. Conclusion: The expression of serum 25 (OH) d is low in children with ASD, and the expression of serum 25 (OH) d is different in children with different severity. Moreover, the level of serum 25 (OH) d is negatively correlated with the total score of cars. It has a certain value as a biomarker to evaluate the severity of ASD.