Golubova T F, Nuvoli A V
Research Institute of Children's Resorts, Physiotherapy and Medical Rehabilitation, Yevpatoria, Russia.
Vopr Kurortol Fizioter Lech Fiz Kult. 2022;99(1):42-49. doi: 10.17116/kurort20229901142.
The continuous increase in the prevalence of autism spectrum disorders (ASD) in the population, the debatable nature of many aspects of etiology, pathogenesis, and treatment of these disorders justify the urgent need for the development of effective medical rehabilitation methods affecting the pathogenetic mechanisms.Exposure of children with ASD to external stimuli in excessive force often leads to the stress-systems response not corresponding to the compensation abilities of the body.
To evaluate the effect of iodine-bromine baths on stress-system indicators in children with ASD.
The study involved 74 children with ASD (F84) aged 3 to 14 years (mean age 6.23±0.37 years) included in the main group (MG). The control group (CG) consisted of 25 healthy children.The examination included detailed history taking, examination by specialists, assessment of disease severity using CARS scale, evaluation of β-endorphin, adrenocorticotropic hormone (ACTH), and cortisol levels in blood serum by ELISA.
Statistically significant increase of β-endorphin, ACTH and cortisol levels (<0.01, <0.05, <0.01, respectively) in children with ASD (compared to those in CG children) was identified. In children without hyperactivity, a moderate increase of these parameters was noted; significantly higher values were observed in children with severe hyperactivity, impulsiveness, and aggression (<0.05, <0.001, respectively). After treatment, there was a statistically significant increase in β-endorphin level in subgroup 1 children who received HRT without IB, while in children of subgroups A and B (<0.05, <0.05, <0.01, respectively), there was a decrease in ACTH level (<0.05, <0.01, <0.001 respectively) and a trend towards a cortisol level decrease. Inclusion of IB in HRT course associated with a significant decrease of β-endorphin level in children of subgroups A and B (<0.001), a decrease of ACTH level (<0.001) and cortisol (<0.001, <0.01, <0.001, respectively), which resulted in vicious circle breaking and normalization of relations between stress-limiting and stress-releasing parts of pathogenesis.
Most children with autism spectrum disorders showed significant increases in β-endorphin, adrenocorticotropic hormone, and cortisol levels, indicating dysfunction between the stress-limiting and stress-releasing systems, as well as between the central and peripheral parts of the stress-releasing chain. The tonic effect of resort treatment was noted, limiting its use in children with autism spectrum disorders, increased hyperactivity, and aggression. The inclusion of iodine-bromine baths in resort treatment has a calming non-medicinal effect and can be recommended for use in children with symptoms of severe hyperactivity.
自闭症谱系障碍（ASD）在人群中的患病率持续上升，这些疾病在病因、发病机制和治疗的许多方面存在争议，这证明迫切需要开发影响发病机制的有效医学康复方法。自闭症谱系障碍儿童受到过度外力的外部刺激，往往会导致应激系统反应与身体的代偿能力不相符。
评估碘溴浴对自闭症谱系障碍儿童应激系统指标的影响。
该研究纳入了74名年龄在3至14岁（平均年龄6.23±0.37岁）的自闭症谱系障碍儿童（F84）作为主要组（MG）。对照组（CG）由25名健康儿童组成。检查包括详细的病史采集、专科医生检查、使用儿童孤独症评定量表（CARS）评估疾病严重程度、通过酶联免疫吸附测定法（ELISA）评估血清中β-内啡肽、促肾上腺皮质激素（ACTH）和皮质醇水平。
与对照组儿童相比，自闭症谱系障碍儿童的β-内啡肽、促肾上腺皮质激素和皮质醇水平有统计学意义的升高（分别为<0.01、<0.05、<0.01）。在无多动症状的儿童中，这些参数有中度升高；在有严重多动、冲动和攻击行为的儿童中观察到显著更高的值（分别为<0.05、<0.001）。治疗后，接受无碘溴浴激素替代疗法（HRT）的1组儿童的β-内啡肽水平有统计学意义的升高，而A组和B组儿童的促肾上腺皮质激素水平下降（分别为<0.05、<0.01、<0.001），且皮质醇水平有下降趋势。在HRT疗程中加入碘溴浴与A组和B组儿童的β-内啡肽水平显著下降（<0.001）、促肾上腺皮质激素水平下降（<0.001）和皮质醇水平下降（分别为<0.001、<0.01、<0.001）相关，这导致恶性循环被打破，发病机制中应激限制和应激释放部分之间的关系正常化。
大多数自闭症谱系障碍儿童的β-内啡肽、促肾上腺皮质激素和皮质醇水平显著升高，表明应激限制和应激释放系统之间以及应激释放链的中枢和外周部分之间存在功能障碍。注意到疗养治疗的滋补作用，这限制了其在患有自闭症谱系障碍、多动和攻击行为增加的儿童中的使用。在疗养治疗中加入碘溴浴具有镇静的非药物作用，可推荐用于有严重多动症状的儿童。
