维生素在孤独症谱系障碍中的作用研究进展
Research Progress on the Role of Vitamins in Autism Spectrum Disorder
DOI: 10.12677/acm.2025.1582294, PDF,    科研立项经费支持
作者: 杜春雨:延安大学延安医学院,陕西 延安;李兴珍*:延安大学附属医院儿科,陕西 延安
关键词: 孤独症谱系障碍(ASD)维生素A维生素B维生素C维生素D维生素EAutism Spectrum Disorder (ASD) Vitamin A Vitamin B Vitamin C Vitamin D Vitamin E
摘要: 孤独症谱系障碍(Autism Spectrum Disorder, ASD)作为一种复杂的以社会沟通和社会互动障碍以及重复刻板行为为主要症状的神经发育障碍性疾病,其病因和发病机制尚不明确。近年来研究发现,ASD患者体内多种维生素的缺乏,可能是导致患者认知功能下降和语言功能障碍的重要原因。本文采用PRISMA指南,系统检索和筛选维生素的基本代谢特点,维生素A、D、C、E以及维生素B1、B2、B6、B9、B12缺乏与ASD的关系,以及补充维生素改善ASD症状等方面的研究,旨在探讨营养干预措施对提高ASD患儿生活质量的潜在价值,以期为今后的研究及治疗提供新的思路,寻找新的作用靶点,同时为临床实践提供更多的指导,帮助医生和家长更有效地支持这一特殊群体儿童的健康发展。
Abstract: Autism Spectrum Disorder (ASD), as a complex neurodevelopmental disorder with social communication and social interaction disorder and repetitive stereotyped behavior as the main symptoms, its etiology and pathogenesis are not clear. Recent studies have found that the deficiency of multiple vitamins in ASD patients may be an important cause of cognitive decline and language dysfunction in patients. This paper uses the PRISMA guidelines to systematically search for and screen the research on the basic metabolic characteristics of vitamins, as well as the relationship between vitamins A, D, C, E, vitamins B1, B2, B6, B9, B12 deficiency and ASD, and the effects of vitamin supplementation on improving ASD symptoms, aiming to explore the potential value of nutritional interventions to improve the quality of life of children with ASD, in order to provide new ideas for future research and treatment, find new targets, and provide more guidance for clinical practice, to help doctors and parents more effectively support the healthy development of this special group of children.
文章引用:杜春雨, 李兴珍. 维生素在孤独症谱系障碍中的作用研究进展[J]. 临床医学进展, 2025, 15(8): 762-771. https://doi.org/10.12677/acm.2025.1582294

参考文献

[1] 刘芸, 李志斌, 徐开寿. 2019年加拿大儿科学会立场声明《孤独症谱系障碍诊断性评估标准》解读[J]. 中国全科医学, 2020, 23(8): 893-900.
[2] 赵亚楠, 李智文, 李琳, 等. 中国0-6岁儿童孤独症谱系障碍筛查患病现状[J]. 中国生育健康杂志, 2023, 34(5): 423-428.
[3] 张明. 维生素A缺乏对神经精神系统影响的蛋白质组学研究[D]: [博士学位论文]. 上海: 上海交通大学, 2009.
[4] Elibol-Can, B., Simsek-Ozek, N., Severcan, F., Severcan, M. and Jakubowska-Dogru, E. (2014) Vitamin a Deficiency Induces Structural and Functional Alterations in the Molecular Constituents of the Rat Hippocampus. British Journal of Nutrition, 113, 45-55. [Google Scholar] [CrossRef] [PubMed]
[5] Olson, C.R. and Mello, C.V. (2010) Significance of Vitamin A to Brain Function, Behavior and Learning. Molecular Nutrition & Food Research, 54, 489-495. [Google Scholar] [CrossRef] [PubMed]
[6] Poudineh, M., Parvin, S., Omidali, M., Nikzad, F. and Nikzad, F. (2023) The Effects of Vitamin Therapy on ASD and ADHD: A Narrative Review. CNS & Neurological Disorders Drug Targets, 22, 711-735.
[7] 刘婧. 健康教育干预对预防儿童维生素A缺乏的效果观察[J]. 临床医药文献电子杂志, 2015, 2(2): 264.
[8] 王斯. 维生素A缺乏对孤独症模型大鼠运动协调功能的影响及可能机制[D]: [博士学位论文]. 重庆: 重庆医科大学, 2021.
[9] 周永华. 维生素A缺乏与疾病的关系及作用机理研究[J]. 重庆医学, 1996(6): 325.
[10] Bandini, L.G., Anderson, S.E., Curtin, C., Cermak, S., Evans, E.W., Scampini, R., et al. (2010) Food Selectivity in Children with Autism Spectrum Disorders and Typically Developing Children. The Journal of Pediatrics, 157, 259-264. [Google Scholar] [CrossRef] [PubMed]
[11] Hyman, S.L., Stewart, P.A., Schmidt, B., Cain, U., Lemcke, N., Foley, J.T., et al. (2012) Nutrient Intake from Food in Children with Autism. Pediatrics, 130, S145-S153. [Google Scholar] [CrossRef] [PubMed]
[12] Liu, X., Liu, J., Xiong, X., Yang, T., Hou, N., Liang, X., et al. (2016) Correlation between Nutrition and Symptoms: Nutritional Survey of Children with Autism Spectrum Disorder in Chongqing, China. Nutrients, 8, Article 294. [Google Scholar] [CrossRef] [PubMed]
[13] Sun, C., Xia, W., Zhao, Y., et al. (2024) Nutritional Status Survey of Children with Autism and Typically Developing Children Aged 4-6 Years in Heilongjiang Province, China. Journal of Nutritional Science, 2, e16.
[14] Guo, M., Li, L., Zhang, Q., Chen, L., Dai, Y., Liu, L., et al. (2018) Vitamin and Mineral Status of Children with Autism Spectrum Disorder in Hainan Province of China: Associations with Symptoms. Nutritional Neuroscience, 23, 803-810. [Google Scholar] [CrossRef] [PubMed]
[15] Cheng, B., Zhu, J., Yang, T., Guo, M., Lai, X., Li, Q., et al. (2020) Vitamin A Deficiency Increases the Risk of Gastrointestinal Comorbidity and Exacerbates Core Symptoms in Children with Autism Spectrum Disorder. Pediatric Research, 89, 211-216. [Google Scholar] [CrossRef] [PubMed]
[16] Zhu, J., Guo, M., Yang, T., Lai, X., Tang, T., Chen, J., et al. (2020) Nutritional Status and Symptoms in Preschool Children with Autism Spectrum Disorder: A Two-Center Comparative Study in Chongqing and Hainan Province, China. Frontiers in Pediatrics, 8, Article 469. [Google Scholar] [CrossRef] [PubMed]
[17] Jiang, W., Yu, Q., Gong, M., Chen, L., Wen, E.Y., Bi, Y., et al. (2012) Vitamin A Deficiency Impairs Postnatal Cognitive Function via Inhibition of Neuronal Calcium Excitability in Hippocampus. Journal of Neurochemistry, 121, 932-943. [Google Scholar] [CrossRef] [PubMed]
[18] Hou, N., Ren, L., Gong, M., Bi, Y., Gu, Y., Dong, Z., et al. (2014) Vitamin A Deficiency Impairs Spatial Learning and Memory: The Mechanism of Abnormal CBP-Dependent Histone Acetylation Regulated by Retinoic Acid Receptor Alpha. Molecular Neurobiology, 51, 633-647. [Google Scholar] [CrossRef] [PubMed]
[19] Yang, T., Chen, L., Dai, Y., Jia, F., Hao, Y., Li, L., et al. (2022) Vitamin A Status Is More Commonly Associated with Symptoms and Neurodevelopment in Boys with Autism Spectrum Disorders—A Multicenter Study in China. Frontiers in Nutrition, 9, Article 851980. [Google Scholar] [CrossRef] [PubMed]
[20] Guo, M., Zhu, J., Yang, T., Lai, X., Liu, X., Liu, J., et al. (2018) Vitamin A Improves the Symptoms of Autism Spectrum Disorders and Decreases 5-Hydroxytryptamine (5-HT): A Pilot Study. Brain Research Bulletin, 137, 35-40. [Google Scholar] [CrossRef] [PubMed]
[21] Carpenter, K.J. (2012) The Discovery of Thiamin. Annals of Nutrition and Metabolism, 61, 219-223. [Google Scholar] [CrossRef] [PubMed]
[22] Lương, K.V.Q. (2013) The Role of Thiamine in Autism. American Journal of Psychiatry and Neuroscience, 1, 22-37. [Google Scholar] [CrossRef
[23] Adams, J.B., Audhya, T., McDonough-Means, S., Rubin, R.A., Quig, D., Geis, E., et al. (2011) Nutritional and Metabolic Status of Children with Autism vs. Neurotypical Children, and the Association with Autism Severity. Nutrition & Metabolism, 8, Article No. 34. [Google Scholar] [CrossRef] [PubMed]
[24] Lonsdale, D., Shamberger, R.J. and Audhya, T. (2002) Treatment of Autism Spectrum Children with Thiamine Tetrahydrofurfuryl Disulfide: A Pilot Study. Neuro Enocrinology Letters, 23, 303-308.
[25] Rossignol, D.A. and Frye, R.E. (2011) Mitochondrial Dysfunction in Autism Spectrum Disorders: A Systematic Review and Meta-Analysis. Molecular Psychiatry, 17, 290-314. [Google Scholar] [CrossRef] [PubMed]
[26] 王宇平, 郭长江, 杨继军, 等. 维生素B2抗急性低氧作用的代谢组学分析[J]. 营养健康新观察, 2012(1): 17-22.
[27] James, S.J., Melnyk, S., Jernigan, S., Cleves, M.A., Halsted, C.H., Wong, D.H., et al. (2006) Metabolic Endophenotype and Related Genotypes Are Associated with Oxidative Stress in Children with Autism. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 141, 947-956. [Google Scholar] [CrossRef] [PubMed]
[28] Frye, R.E. (2020) Mitochondrial Dysfunction in Autism Spectrum Disorder: Unique Abnormalities and Targeted Treatments. Seminars in Pediatric Neurology, 35, Article ID: 100829. [Google Scholar] [CrossRef] [PubMed]
[29] Zheng, L., Jiao, Y., Zhong, H., Tan, Y., Yin, Y., Liu, Y., et al. (2024) Human-Derived Fecal Microbiota Transplantation Alleviates Social Deficits of the BTBR Mouse Model of Autism through a Potential Mechanism Involving Vitamin B6 Metabolism. mSystems, 9, e00257-24. [Google Scholar] [CrossRef] [PubMed]
[30] Parra, M., Stahl, S. and Hellmann, H. (2018) Vitamin B6 and Its Role in Cell Metabolism and Physiology. Cells, 7, Article 84. [Google Scholar] [CrossRef] [PubMed]
[31] Sato, K. (2018) Why Is Vitamin B6 Effective in Alleviating the Symptoms of Autism? Medical Hypotheses, 115, 103-106. [Google Scholar] [CrossRef] [PubMed]
[32] Adams, J.B., Audhya, T., McDonough-Means, S., Rubin, R.A., Quig, D., Geis, E., et al. (2011) Effect of a Vitamin/Mineral Supplement on Children and Adults with Autism. BMC Pediatrics, 11, Article No. 111. [Google Scholar] [CrossRef] [PubMed]
[33] James, B., et al. (2018) Comprehensive Nutritional and Dietary Intervention for Autism Spectrum Disorder—A Randomized, Controlled 12 Month Trial. Nutrients, 10, Article 369.
[34] Li, Y.-J., Li, Y.-M. and Xiang, D.-X. (2017) Supplement Intervention Associated with Nutritional Deficiencies in Autism Spectrum Disorders: A Systematic Review. European Journal of Nutrition, 57, 2571-2582. [Google Scholar] [CrossRef] [PubMed]
[35] Vasconcelos, C., Perry, I.S., Gottfried, C., Riesgo, R. and Castro, K. (2024) Folic Acid and Autism: Updated Evidences. Nutritional Neuroscience, 28, 273-307. [Google Scholar] [CrossRef] [PubMed]
[36] Adams, M., Lucock, M., Stuart, J., Fardell, S., Baker, K. and Ng, X. (2007) Preliminary Evidence for Involvement of the Folate Gene Polymorphism 19bp Deletion-DHFR in Occurrence of Autism. Neuroscience Letters, 422, 24-29. [Google Scholar] [CrossRef] [PubMed]
[37] Sener, E.F., Oztop, D.B. and Ozkul, Y. (2014) MTHFR Gene C677T Polymorphism in Autism Spectrum Disorders. Genetics Research International, 2014, Article ID: 698574.
[38] Rai, V. (2016) Association of Methylenetetrahydrofolate Reductase (MTHFR) Gene C677T Polymorphism with Autism: Evidence of Genetic Susceptibility. Metabolic Brain Disease, 31, 727-735. [Google Scholar] [CrossRef] [PubMed]
[39] Pu, D., Shen, Y. and Wu, J. (2013) Association between MTHFR Gene Polymorphisms and the Risk of Autism Spectrum Disorders: A Meta-Analysis. Autism Research, 6, 384-392. [Google Scholar] [CrossRef] [PubMed]
[40] 何一, 王娟. 孤独症谱系障碍与叶酸代谢的研究进展[J]. 国际儿科学杂志, 2018, 45(11): 880-883.
[41] Magnus, P., Birke, C., Vejrup, K., Haugan, A., Alsaker, E., Daltveit, A.K., et al. (2016) Cohort Profile Update: The Norwegian Mother and Child Cohort Study (MoBa). International Journal of Epidemiology, 45, 382-388. [Google Scholar] [CrossRef] [PubMed]
[42] Liu, X., Zou, M., Sun, C., Wu, L. and Chen, W. (2021) Prenatal Folic Acid Supplements and Offspring’s Autism Spectrum Disorder: A Meta-Analysis and Meta-Regression. Journal of Autism and Developmental Disorders, 52, 522-539. [Google Scholar] [CrossRef] [PubMed]
[43] 余晓芳, 李梅, 郑艳. 母亲孕期补充叶酸与其子女孤独症谱系障碍发病风险的Meta分析[J]. 中国当代儿科杂志, 2017, 19(3): 286-291.
[44] Hunt, A., Harrington, D. and Robinson, S. (2014) Vitamin B12 Deficiency. BMJ, 349, g5226. [Google Scholar] [CrossRef] [PubMed]
[45] Green, R., Allen, L.H., Bjørke-Monsen, A.L., Brito, A., Guéant, J.L., Miller, J.W., et al. (2017) Vitamin B12 Deficiency. Nature Reviews Disease Primers, 3, Article No. 17040.
[46] Green, R. and Miller, J.W. (2022) Vitamin B12 Deficiency. Vitamins and Hormones, 119, 405-439.
[47] Hendren, R.L., James, S.J., Widjaja, F., Lawton, B., Rosenblatt, A. and Bent, S. (2016) Randomized, Placebo-Controlled Trial of Methyl B12 for Children with Autism. Journal of Child and Adolescent Psychopharmacology, 26, 774-783. [Google Scholar] [CrossRef] [PubMed]
[48] Metyas, M.M., Abdelhakim, A.S. and Ghandour, H.H. (2020) Screening of Vitamin B12 in Children Diagnosed as Autism Spectrum Disorder. QJM: An International Journal of Medicine, 113, hcaa063.006. [Google Scholar] [CrossRef
[49] Raghavan, R., Riley, A.W., Volk, H., Caruso, D., Hironaka, L., Sices, L., et al. (2017) Maternal Multivitamin Intake, Plasma Folate and Vitamin B12 levels and Autism Spectrum Disorder Risk in Offspring. Paediatric and Perinatal Epidemiology, 32, 100-111. [Google Scholar] [CrossRef] [PubMed]
[50] El-Ansary, A., Bjørklund, G., Chirumbolo, S. and Alnakhli, O.M. (2017) Predictive Value of Selected Biomarkers Related to Metabolism and Oxidative Stress in Children with Autism Spectrum Disorder. Metabolic Brain Disease, 32, 1209-1221. [Google Scholar] [CrossRef] [PubMed]
[51] Kothari, P., Tate, A., Adewumi, A., Kinlin, L.M. and Ritwik, P. (2020) The Risk for Scurvy in Children with Neurodevelopmental Disorders. Special Care in Dentistry, 40, 251-259. [Google Scholar] [CrossRef] [PubMed]
[52] Meguid, N.A., Anwar, M., Bjørklund, G., Hashish, A., Chirumbolo, S., Hemimi, M., et al. (2017) Dietary Adequacy of Egyptian Children with Autism Spectrum Disorder Compared to Healthy Developing Children. Metabolic Brain Disease, 32, 607-615. [Google Scholar] [CrossRef] [PubMed]
[53] Marí-Bauset, S., Llopis-González, A., Zazpe-García, I., Marí-Sanchis, A. and Morales-Suárez-Varela, M. (2014) Nutritional Status of Children with Autism Spectrum Disorders (ASDs): A Case-Control Study. Journal of Autism and Developmental Disorders, 45, 203-212. [Google Scholar] [CrossRef] [PubMed]
[54] 白瑜, 冯自立. 维生素D受体(VDR)对中枢神经系统功能作用的研究进展[J]. 生命科学, 2018, 30(7): 716-722.
[55] 王萍, 钟建民. 维生素D在孤独症谱系障碍发病机制中的研究进展[J]. 中华实用儿科临床杂志, 2021, 36(2): 158-160.
[56] Cannell, J.J. (2017) Vitamin D and Autism, What’s New? Reviews in Endocrine and Metabolic Disorders, 18, 183-193. [Google Scholar] [CrossRef] [PubMed]
[57] Kittana, M., Ahmadani, A., Stojanovska, L. and Attlee, A. (2021) The Role of Vitamin D Supplementation in Children with Autism Spectrum Disorder: A Narrative Review. Nutrients, 14, Article 26. [Google Scholar] [CrossRef] [PubMed]
[58] Ali, A., Cui, X. and Eyles, D. (2018) Developmental Vitamin D Deficiency and Autism: Putative Pathogenic Mechanisms. The Journal of Steroid Biochemistry and Molecular Biology, 175, 108-118. [Google Scholar] [CrossRef] [PubMed]
[59] Pulikkan, J., Maji, A., Dhakan, D.B., Saxena, R., Mohan, B., Anto, M.M., et al. (2018) Gut Microbial Dysbiosis in Indian Children with Autism Spectrum Disorders. Microbial Ecology, 76, 1102-1114. [Google Scholar] [CrossRef] [PubMed]
[60] Yamamoto, E. and Jørgensen, T.N. (2019) Immunological Effects of Vitamin D and Their Relations to Autoimmunity. Journal of Autoimmunity, 100, 7-16. [Google Scholar] [CrossRef] [PubMed]
[61] Atkinson, J., Epand, R.F. and Epand, R.M. (2008) Tocopherols and Tocotrienols in Membranes: A Critical Review. Free Radical Biology and Medicine, 44, 739-764. [Google Scholar] [CrossRef] [PubMed]
[62] Zingg, J. and Azzi, A. (2004) Non-Antioxidant Activities of Vitamin E. Current Medicinal Chemistry, 11, 1113-1133. [Google Scholar] [CrossRef] [PubMed]
[63] Azzi, A. (2007) Molecular Mechanism of α-Tocopherol Action. Free Radical Biology and Medicine, 43, 16-21. [Google Scholar] [CrossRef] [PubMed]
[64] Alabdali, A., Al-Ayadhi, L. and El-Ansary, A. (2014) A Key Role for an Impaired Detoxification Mechanism in the Etiology and Severity of Autism Spectrum Disorders. Behavioral and Brain Functions, 10, Article No. 14. [Google Scholar] [CrossRef] [PubMed]
[65] Herndon, A.C., Diguiseppi, C. and Johndon, S.L. (2008) Dose Nutritional Intake Differs between Children with Autism Spectrum Disorder and Children with Typical Development? Journal of Autism and Developmental Disorders, 6, 341-349.
[66] da Cunha Germano, B.C., de Morais, L.C.C., Idalina Neta, F., Fernandes, A.C.L., Pinheiro, F.I., do Rego, A.C.M., et al. (2023) Vitamin E and Its Molecular Effects in Experimental Models of Neurodegenerative Diseases. International Journal of Molecular Sciences, 24, Article 11191. [Google Scholar] [CrossRef] [PubMed]
[67] Modabbernia, A., Velthorst, E. and Reichenberg, A. (2017) Environmental Risk Factors for Autism: An Evidence-Based Review of Systematic Reviews and Meta-Analyses. Molecular Autism, 8, Article No. 13. [Google Scholar] [CrossRef] [PubMed]
[68] Bjørklund, G., Meguid, N.A., Dadar, M., Pivina, L., Kałużna-Czaplińska, J., Jóźwik-Pruska, J., et al. (2020) Specialized Diet Therapies: Exploration for Improving Behavior in Autism Spectrum Disorder (ASD). Current Medicinal Chemistry, 27, 6771-6786. [Google Scholar] [CrossRef] [PubMed]