Correlation Analysis Of Vitamin A And D Levels With Tic Disorders And Their Comorbidities Attention Deficit Hyperactivity Disorder

Tic disorder(TD)is a neuropsychiatric disease characterized by motor tic and vocal tic,which was first discovered and described by the French doctor Tourette in 1885.While in our country,the first case was reported as early as 1963.TD prevalence rate has been increasing year by year in recent years,which seriously harm the physical and mental health of the children.Therefore,it is very important to find laboratory indicators to assist TD diagnosis and disease assessment.Deficiency or deficiency of vitamin A(VA)and vitamin D(VD)in children’s development stage affects the normal development of the dopamine system.Most domestic and foreign scholars believe that the causes of TD and ADHD are closely related to neurotransmitter abnormalities,and most of them tend to be related to the abnormal function of the dopamine system.At present,there are few analyses of VA and VD levels,tic disorders and their co-existing ADHD levels at home and abroad.In this study,183 children with TD and 62 healthy children with physical examination were selected for casecontrol study to analyze the relationship between VA and VD levels and TD,so as to provide reference for disease prevention,diagnosis,disease evaluation and treatment.Objective:To explore the relationship between VA and VD levels and the severity,clinical classification and comorbidity ADHD of TD,and to study the correlation between VA and VD levels in children with TD,in order to provide laboratory basis for the prevention and treatment of TD and co-morbidity ADHD,and to provide reference for the disease assessment and prognosis of TD.Methods:1.A case-control study was used in this study.In this study,a total of 183 children with TD who visited the clinic for the first time were selected as the case group according to 《Expert Consensus on the Diagnosis and Treatment of Tic Disorders in Children(2017 Practical Edition)》.Case groups were divided into TD group and TD comorbidities ADHD group according to DSM-5 diagnostic criteria,including 152 cases in TD group and 31 cases in TD comorbidities ADHD group.According to the YGTSS scale,they were divided into mild TD group,moderate TD group and severe TD group,among which 112 cases were mild TD group,38 cases were moderate TD group and 33 cases were severe TD group.According to the clinical classification of TD,the patients were divided into PTD group,CTD group and TS group,including 91 cases in PTD group,33 cases in CTD group and 59 cases in TS group.Sixtytwo healthy children in our hospital during the same period were selected as the control group.2.The specialized doctors made one-to-one detailed inquiries to the enrolled children and their guardians to learn about the basic information and family situation of the children,to determine whether the TD children had comorbidities ADHD according to the DSM-5 diagnostic criteria for attention deficit hyperactivity disorder,and to assess the severity of the TD children through the Yale Comprehensive Tic Severity Scale(YGTSS).And the clinical classification of children with TD was evaluated according to the 《Expert Consensus on the Diagnosis and Treatment of Tic Disorders in Children(2017 Practical Edition)》on the clinical classification of TD.3.The American ACQUITY-I-X Ultra high performance liquid chromatography tandem mass spectrometry system was used to determine the levels of VA and VD.4.Statistical methods:measurement data using mean±standard deviation((?)±s)said,count data using the number of cases and percentile cases(%)said.Analysis of variance and Bonferroni test were used to compare the mean of multiple groups.Spearman correlation coefficient was used to analyze the correlation between vitamin A and D levels and YGTSS scale score in the case group,and Pearson correlation coefficient was used to study the correlation between VA and VD in the case group and the control group.Multivariate binary Logistic regression was used to analyze whether VA and VD were independent influencing factors of TD.When P<0.05,the difference was statistically significant.Results:1.Comparison of VA and VD levels of children in TD comorbidities afflicted ADHD group,TD group and control groupThe case group was divided into TD group and TD comorbidities ADHD group according to whether they had ADHD.The VA and VD levels of the case group(TD group and TD comorbidities ADHD group)and the control group were compared(P<0.05),and the differences were statistically significant,and the VA and VD levels of the control group,TD group and TD comorbidities ADHD group showed a downward trend.Compared with TD group and TD comorbidities ADHD group,VA and VD levels in the control group were statistically significant(P < 0.05);compared with TD comorbidities ADHD group,VD levels in the TD group were statistically significant(P<0.05),while VA levels were not statistically significant(P > 0.05),as shown in Table 2、Fig.1.2.Comparison of VA and VD levels among children with different severity of TDAccording to the YGTSS scoring scale,the case group was divided into mild TD group,moderate TD group and severe TD group.The VA and VD levels were compared between the case group(mild TD group,moderate TD group and severe TD group)and the control group,and the difference was statistically significant(P < 0.05).In addition,the contents of VA and VD in control group,mild TD group,moderate TD group and severe TD group showed a decreasing trend,and there were statistically significant differences in VA and VD levels among all groups(P < 0.05),as shown in Table 3、Fig.2.3.Analysis of correlation between VA and VD levels and the severity of TD childrenSpearman correlation coefficient analysis showed that YGTSS scale score was negatively correlated with VA and VD levels in the case group(r=-0.596,P < 0.001;r=-0.704,P < 0.001),as shown in Fig.3 and 4.4.Comparison of VA and VD levels among children with different clinical classification with TDCase group was divided into PTD group,CTD group and TS group according to the clinical classification criteria of 《Expert Consensus on the Diagnosis and Treatment of Tic Disorders in Children(2017 Practical Edition)》.Compared with control group,case group(PTD group,CTD group and TS group)showed the lowest levels of VA and VD in TS group,followed by CTD group and PTD group,and the highest levels of VA and VD in control group.The difference was statistically significant(P < 0.05).There were statistically significant differences in VA and VD levels between TS group and PTD group,CTD group and control group(P < 0.05).There were statistically significant differences in VA and VD levels between control group and CTD group(P <0.05).There was statistical significance in VD level between PTD group and CTD group(P < 0.05),but no statistical significance in VA level between PTD group and CTD group(P > 0.05).There was no statistical significance in VA and VD levels between control group and PTD group(P > 0.05),as shown in Table 4、Fig.5.5.Correlation analysis of VA and VD in children in the case group and the control groupBy Pearson correlation coefficient analysis,VA and VD were positively correlated in the case group(r= 0.580,P < 0.001),as shown in Fig.6.There was no significant correlation between VA and VD in the control group(r=0.020,P > 0.05).6.Logistic regression analysis of VA and VDTook whether there was tic disorder as the dependent variable and VA and VD as the independent variable.Logistic regression model was incorporated into the single factor regression analysis,and the results showed that there was a significant correlation between VA and VD level and TD(P<0.05;P <0.001;).VA(β=-0.009;OR=0.985;95%CI: 0.985-0.997)and VD(β=-1.50;OR=0.860;95%CI: 0.803-0.922)may be a protective factor for tic disorders,as shown in Table 5 and Fig.7.Conclusions:1.Vitamin A and vitamin D levels are associated with the onset of tic disorder and its comorbidities attention deficit hyperactivity disorder,and vitamin A and vitamin D levels are reduced in children with tic disorder and its comorbidities attention deficit hyperactivity disorder.2.The level of vitamin A and vitamin D was negatively correlated with the severity of TD in children with tic disorder.The lower the level of vitamin A and vitamin D,the more severe the disease.3.Vitamin A and vitamin D levels were correlated with the clinical classification of tic disorders,and the lowest levels were found in children with Tourette syndrome.4.There was a positive correlation between vitamin A level and vitamin D level in tic disorder children,but no correlation between vitamin A level and vitamin D level in control group.