目的 通过检测孤独症谱系障碍(ASD)儿童血清不耐受食物和肠道菌群,分析食物不耐受(FI)与ASD儿童胃肠道症状的相关性,并探讨FI对ASD儿童行为影响的可能机制.方法 选取2020年1-12月就诊于泉州市妇幼保健院·儿童医院康复科2～6岁ASD儿童95例,采用酶联免疫法(ELISA)检测14种血清食物特异性IgG,并依据血清食物特异性IgG抗体检测水平评估FI程度.依据FI检测结果将入组ASD儿童分为FI组(52例)及无FI组(43例).两组儿童均采用自行设计的ASD儿童胃肠道症状评估调查表进行评估,并采用16S高通量基因测序法检测粪便中肠道菌群的分布状况.结果 ①FI组腹胀、便秘、呕吐及按压腹部同时哭闹发生率显著高于无FI组,差异均有统计学意义(x2=6.924、5.573、4.198、4.533,P＜0.05).②FI水平与腹胀、便秘、恶心及按压腹部同时哭闹存在正相关(r=0.341、0.428、0.340、0.227,均P＜0.05).③FI组chao1数值、拟杆菌数量、大肠埃希菌数量及乳酸杆菌相对数量显著高于无FI组,差异均有统计学意义(t=8.207、10.469、11.090、2.229,P＜0.05);FI组双歧杆菌数量显著低于无FI组,差异有统计学意义(t=-2.862,P＜0.05).结论 伴有FI的ASD存在较多的胃肠道症状,FI与部分胃肠道症状密切相关,对存在胃肠道问题的ASD儿童应注意有无FI.FI儿童存在更为明显的肠道菌群紊乱.

目的 分析孤独症谱系障碍(ASD)儿童肠道菌群与症状严重程度的关系.方法 选择2020年6月至2021年6月于泉州市妇幼保健院·儿童医院就诊的90例ASD患儿作为研究对象,按照孤独症治疗评定量表评估得分将其分为轻度组(41例)、中度组(39例)、重度组(10例),采用16S高通量基因测序测量其肠道菌群,比较三组的菌群的相对丰度以及与症状严重程度的相关性.结果 重度组的链球菌属、埃希氏菌属、真杆菌属、梭杆菌属、肠道菌群相对丰度均低于轻度组、中度组,差异有统计学意义(P＜0.05);中度组的链球菌属、埃希氏菌属、真杆菌属、梭杆菌属、肠道菌群相对丰度均低于轻度组,差异有统计学意义(P＜0.05);重度组的巨球型菌属、巨单胞菌属、铜绿假单胞菌、肠道巴恩斯氏菌的相对丰度均高于轻度组、中度组,差异有统计学意义(P＜0.05);中度组的巨球型菌属、巨单胞菌属、铜绿假单胞菌、肠道巴恩斯氏菌的相对丰度均高于轻度组,差异有统计学意义(P＜0.05).链球菌属、埃希氏菌属、真杆菌属、梭杆菌属的相对丰度与ASD严重程度呈负相关(P＜0.001),巨球型菌属、巨单胞菌属、铜绿假单胞菌、肠道巴恩斯氏菌的相对丰度与ASD严重程度的关系呈正相关(P＜0.001).结论 ASD儿童的肠道菌群分布情况与症状的严重程度存在相关性.

Background Health-related risky behaviors (HRB) generally refer to behaviors that have a negative influence on health and quality of life. HRB in adolescents with autism have not been well understood so far. We aim to explore health-related risky behaviors and their risk factors with autistic adolescents. Methods In this study, 150 adolescents with autism and 150 neurotypical adolescents were enrolled. Participants in both groups completed the Adolescent Health-Related Risky Behavior Inventory (AHRBI). Autism Spectrum Screening Questionnaire (ASSQ), Wechsler Intelligence Scale, Theory of Mind (ToM) Test, Zung Self-rating Anxiety Scale (SAS), Zung Self-rating Depression Scale (SDS), and Self-Esteem Scale (SES) were also assessed in the autism group to explore risk factors. Results The results showed that the total score of AHRBI and scores of "aggression and violence (AV)", "suicide or self-injury (SS)", "health-compromising behavior (HCB)", and "unprotected sex (US)" subscales in the autism group were significantly higher than those in the control group (Z value = − 4.58 ~ − 2.26, all P < 0.05). Anxiety, depression, low self-esteem, low IQ score, low ToM test score, increasing age, and communication disorder were found as risk factors for health-related risky behaviors in autistic adolescents. Conclusions Adolescents with autism have more health-related risky behaviors than neurotypical adolescents. We should pay attention to the emotional state, self-esteem, cognitive function, and verbal communication levels of autistic adolescent with health-related risky behaviors.

BACKGROUND:Health-related risky behaviors generally refer to behaviors that have a negative impact on health and quality of life. Health-related risky behaviors in adolescents with high-functioning autism (HFA) have not been well understood so far. Adolescents with HFA may have more health-related risky behaviors than neurotypical adolescents.AIM:To investigate health-related risky behaviors and their risk factors with HFA.METHODS:This is an observational study. Our study enrolled 110 adolescents aged 12-19-years-old meeting Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria for HFA. They were recruited from Peking University Sixth Hospital. There were also 110 age, sex and nationality matched controls enrolled who came from a public school in Beijing, China. Both groups completed the Adolescents Health-related Risky Behavior Inventory. Nonparametric tests were carried out for comparison of the Adolescents Health-related Risky Behavior Inventory scores between the two groups. Expression recognition, the Inventory of Subjective Life Quality for Child and Adolescent, Chinese Wechsler Intelligence Scale for Children, Wechsler Intelligence Scale for Adult-Chinese Revised, Theory of Mind test and Autism Spectrum Screening Questionnaire were assessed in the autism group to explore factors associated with health-related risky behaviors. Multivariate regression analysis was conducted to explore the risk factors of health-related risky behaviors in the HFA group.RESULTS:The results showed that the total score of the Adolescents Health-related Risky Behavior Inventory and scores of "aggression and violence," "suicide and self-injury," "health compromising behavior" and "unprotected sex" subscales in the HFA group were significantly higher than those in the control group (Z range -4.197 to -2.213, P < 0.05). Among the associated factors, poor emotional experience (B = -0.268, P < 0.001), depression (B = -0.321, P < 0.001), low score of intelligence (B = -0.032, P = 0.042), low score of Theory of Mind test (B = -1.321, P = 0.003) and poor adaptation to school life (B = -0.152, P = 0.006) were risk factors. These risky behaviors may promote the occurrence of health-related risky behaviors in adolescents with HFA.CONCLUSION:This study showed that adolescents with HFA were more likely to be involved in health-related risky behaviors. Different health-related risky behaviors have different reasons.

目的:探讨分析重复经颅磁刺激(rTMS)对孤独症谱系障碍患儿睡眠障碍的影响.方法:选取笔者所在医院2018年10月-2019年10月收治的54例孤独症谱系障碍患儿,随机分为对照组(n=27)和研究组(n=27),两组患儿均接受感觉统合、智训与针灸治疗,在此基础之上给予研究组患儿rTMS,对两组患儿治疗效果进行比较.结果:研究组治疗总有效率为70.37％,高于对照组的55.56％,差异有统计学意义(P<0.05);研究组治疗满意度为66.67％,高于对照组的48.15％,差异有统计学意义(P<0.05).结论:给予孤独症谱系障碍患儿rTMS联合智训与针灸治疗和感觉统合治疗,可以有效改善患儿睡眠障碍,促进疾病恢复,值得推广应用.

目的:研究重复经颅磁刺激联合康复训练对语言发育迟缓患儿发育商、语言发育商的影响.方法:本次纳入2018年11月至2019年11月收治的80例语言发育迟缓患儿展开研究,按照随机数字表法分为两组,对照组40例实施康复训练,观察组40例实施重复经颅磁刺激联合康复训练.将两组的发育商、语言发育商、临床疗效进行比对.结果:观察组患儿治疗后的发育商(89.10±10.64)分、语言发育商(87.74±12.51)分以及临床总有效率(97.50％)均高于对照组,差异具有统计学意义(P＜0.05).结论:对语言发育迟缓患儿实施重复经颅磁刺激联合康复训练的疗效显著,可促进患儿发育商、语言发育商的改善.

目的:研究重复经颅磁刺激结合语言训练对孤独症儿童语言康复的疗效.方法:选取2018年5月-2019年4月来笔者所在医院就诊的孤独症儿童共68例,依据随机数字法均分为两组,对照组单纯行语言训练治疗,观察组行重复经颅磁刺激结合语言训练,对比两组治疗前后CARS、ABC评分、DQ值及语言康复疗效.结果: 观察组治疗后CARS、ABC评分均低于对照组,DQ值高于对照组,差异均有统计学意义(P＜0.05).观察组语言康复治疗总有效率为88.23%,高于对照组的67.65%,差异有统计学意义(P＜0.05).结论:重复经颅磁刺激结合语言训练治疗孤独症效果理想,能有效改善患儿孤独症症状,促进语言康复,值得临床推广.

Objective To investigate the characteristics of health-related risky behaviors in adolescents with High Functioning Autism (HFA). Methods Fifty adolescents aged 12-18 years, IQ≥70 and meeting the criteria of autistic disorder in Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-Ⅳ), and 50 age-and gendermatched healthy controls were recruited. The health-related risky behaviors of all subjects were assessed with the Adolescents Health-related Risky Behavior Inventory (AHRBI). The parents of autistic subjects completed the Adolescents Health-related Risky Behavior Inventory for Parent (AHRBI-P). Results HFA group had higher total scale score and four subscales' scores of AHRBI than controls, including Suicide and Self-Injury (SS), HealthCompromising Behavior (HCB), Aggression and Violence (AV) and Rule Breaking (RB) (all P＜0.05). HFA group had higher scores than controls in the items of "Bullying/Threatening/Intimidating partner", "Deliberately pushing and shoving others", "Not drinking milk/soy milk", "Not participating in any form of physical activity", "Skiping class/Playing truant", "Running away from home", "Biting/Scratching/Bumping to hurt oneself" (all P＜0.05). Among all the subscales and items, the scores of HCB, SS, "Not drinking milk/soy milk", "Physical discomfort due to dieting", "Fighting and Arms-taking" and "Drinking" of self-assessment in HFA group were higher than those of parents' assessment (all P＜0.05]. Conclusion The adolescents with HFA have more health-related risky behaviors than the healthy adolescents except for Smoking and Drinking (SD) and Unprotected sex (US).

目的 分析学龄前期孤独症谱系障碍(ASD)儿童情绪行为问题及其与母亲焦虑、抑郁情绪的相关性,以期全面干预ASD儿童及其家庭.方法 选取2018年1-8月于泉州市儿童医院就诊的5～6岁孤独症儿童71名,并同期入组性别、年龄、母亲受教育程度相匹配的正常学龄前期儿童71名;对所有被试进行Achenbach儿童行为量表(CBCL) (4～16岁版)评定,同时由其母亲完成焦虑自评量表(SAS)和抑郁自评量表(SDS)的评定.结果 1)孤独症男童组的CBCL总分、交往不良、多动、违纪、社交退缩和攻击性因子分高于正常对照组(Z值分别为-6.880、-9.417、-5.745、-5.109、-8.869、-3.510,P＜0.001),体诉因子分低于正常对照组(Z=-2.767,P=0.006).ASD女童组的CBCL总分、多动、残忍、社交退缩、分裂强迫和攻击性因子分均高于正常对照组(Z值分别为-3.726、-3.356、-2.292、-4.339、-2.226、-2.476,P＜0.05).2)两组ASD儿童母亲的SAS、SDS总分均高于正常对照组(Z值分别为-6.848、-3.126、-6.385、-2.183,P＜0.05).3)ASD男童母亲的SAS、SDS总分与ASD男童的CBCL总分、多动、违纪、攻击性、体诉、抑郁、强迫因子分均存在正相关关系(P＜0.05);ASD女童母亲的SAS、SDS总分与ASD女童的攻击性因子分存在正相关关系(P＜0.05).结论 学龄前期ASD儿童存在较多的情绪行为问题,其母亲存在较多的焦虑、抑郁情绪;两者间存在一定相关关系;应对学龄前期ASD儿童的情绪行为问题及其母亲的焦虑抑郁情绪予以关注和干预.

目的:探讨早期家庭干预对儿童生长发育的影响.方法:将2009 年01 月至2011 年01 月在我院体检的64 例幼儿(1-3 岁)分为干预组(32 例)(家长同意接受培训并进行家庭干预)和对照组(32 例)(家长拒绝培训及家庭干预),其中干预组接受系统的家庭干预训练,由专人定期进行体格发育与神经系统检查及智力测定;两组患儿均由专人定期进行体格发育测定.结果:两组患儿在性别、年龄、父母文化水平、职业分布、经济收入、家庭结构及居住社会环境均相仿.研究组儿童身高118.5±10.7cm;体重为20.1±9.47kg;正常对照组儿童身高为103.1±8.16cm;体重为15.9±11.34kg.研究组儿童在体格发育方面研究组落后于正常对照组.差异有显著性(P<0.05).结论:早期家庭干预可促进儿童生长发育.