Wu Xiao-Ping, Fang Rong-Rong, Ji Ting-Ting
Department of Pediatrics, Qingdao Chengyang People's Hospital, Qingdao 266109, Shandong Province, China.
World J Psychiatry. 2024 Aug 19;14(8):1208-1215. doi: 10.5498/wjp.v14.i8.1208.
Tourette syndrome (TS) is a neurodevelopmental disorder characterized by the presence of motor and vocal tics, typically beginning in childhood. Despite significant research efforts, the exact pathophysiology of TS remains incompletely understood. Recent studies suggest that inflammation may play a role in the severity and progression of TS, pointing to the potential influence of dietary and lifestyle factors on the condition. Currently, research on the specific connection between dietary inflammatory index (DII) and TS is still in its early stages, requiring additional clinical and epidemiological studies to validate the strength and specific mechanisms of this connection.
To investigate the association between DII and the severity, recurrence, and inflammatory levels of TS in children.
A total of 207 children diagnosed with TS in the pediatric department of Qingdao Chengyang People's Hospital from January 2022 to January 2023 were selected. They were divided into stable and unstable groups based on follow-up conditions. Before enrollment, general information of the children [age, gender, body mass index (BMI), guardian's education level, DII score, medical history, family history, academic stress, electronic device usage, medication, and disease progression] was assessed, and serum inflammatory levels were measured during follow-up visits. DII scores and Yale Global Tic Severity Scale (YGTSS) scores were calculated. Furthermore, based on YGTSS scores, the children were classified into mild, moderate, and severe groups. The DII, interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-alpha (TNF-α) levels in each group were compared.
Follow-up surveys were completed by 207 children and their guardians. Among them, 117 children were in the stable group, and 90 were in the recurrent group. We found no statistically significant differences in age, gender, comorbidities, BMI, and disease duration between the two groups ( > 0.05). However, academic stress, electronic device usage, medication, guardian's education level, and DII scores showed statistically significant differences between the groups ( < 0.05). Multifactorial regression analysis revealed that guardian's anxiety level, DII score, medication, academic stress, and family history were statistically significant factors ( < 0.05) affecting the recurrence of TS in children. Therefore, anxiety level, DII score, medication status, electronic device usage, and academic stress were identified as factors influencing the recurrence of TS in children. Among them, DII score, academic stress, and family history had odds ratios (OR) greater than 1, indicating risk factors, whereas medication status and guardian's education level had OR values less than 1, indicating protective factors. According to the YGTSS scores, children were categorized into mild, moderate, and severe groups. Comparative analysis of DII and inflammatory levels in children with different degrees of tic disorders revealed that the severe group had the highest DII and inflammatory levels, followed by the moderate group, and the mild group had the lowest levels. The trend of TS progression was consistent with the DII results. Receiver operating characteristic curves were plotted to predict disease progression in patients with TS inflammatory markers. The areas under the curve for IL-6, CRP, and TNF-α were 0.894 (95%CI: 0.817-0.969), 0.793 (95%CI: 0.694-0.893), and 0.728 (95%CI: 0.614-0.843) respectively, with statistically significant differences ( < 0.05). According to the Youden index, the optimal cutoff values were IL-6 = 3.775 ng/L (sensitivity 68.1% and specificity 68.4%), CRP = 6.650 mg/L (sensitivity 60.6% and specificity 68.4%), and TNF-α = 0.666 (sensitivity 60.6% and specificity 71.1%).
We found a certain correlation between DII and the severity, recurrence, and inflammatory levels of TS in children. Reasonable reduction in the intake of pro-inflammatory foods may be beneficial in reducing the risk of disease progression in children with TS.
抽动秽语综合征（TS）是一种神经发育障碍，其特征为存在运动性和发声性抽动，通常始于儿童期。尽管进行了大量研究，但TS的确切病理生理学仍未完全明确。近期研究表明，炎症可能在TS的严重程度和进展中起作用，这表明饮食和生活方式因素可能对该病产生潜在影响。目前，关于饮食炎症指数（DII）与TS之间具体联系的研究仍处于早期阶段，需要更多的临床和流行病学研究来验证这种联系的强度和具体机制。
探讨DII与儿童TS的严重程度、复发情况及炎症水平之间的关联。
选取2022年1月至2023年1月在青岛城阳人民医院儿科确诊为TS的207例儿童。根据随访情况将其分为病情稳定组和复发组。在入组前，评估儿童的一般信息[年龄、性别、体重指数（BMI）、监护人教育水平、DII评分、病史、家族史、学业压力、电子设备使用情况、用药情况及疾病进展]，并在随访期间测量血清炎症水平。计算DII评分和耶鲁综合抽动严重程度量表（YGTSS）评分。此外，根据YGTSS评分将儿童分为轻度、中度和重度组。比较各组的DII、白细胞介素-6（IL-6）、C反应蛋白（CRP）和肿瘤坏死因子-α（TNF-α）水平。
207例儿童及其监护人完成了随访调查。其中，病情稳定组117例，复发组90例。两组在年龄、性别、合并症、BMI和病程方面差异无统计学意义（P>0.05）。然而，两组在学业压力、电子设备使用情况、用药情况、监护人教育水平和DII评分方面差异有统计学意义（P<0.05）。多因素回归分析显示，监护人焦虑水平、DII评分、用药情况、学业压力和家族史是影响儿童TS复发的统计学显著因素（P<0.05）。因此，焦虑水平、DII评分、用药状态、电子设备使用情况和学业压力被确定为影响儿童TS复发的因素。其中，DII评分、学业压力和家族史的比值比（OR）大于1，表明为危险因素，而用药状态和监护人教育水平的OR值小于1，表明为保护因素。根据YGTSS评分，将儿童分为轻度、中度和重度组。对不同程度抽动障碍儿童的DII和炎症水平进行比较分析，发现重度组的DII和炎症水平最高，其次是中度组，轻度组最低。TS进展趋势与DII结果一致。绘制受试者工作特征曲线以预测TS患者炎症标志物的疾病进展。IL-6、CRP和TNF-α的曲线下面积分别为0.894（95%CI：0.817-0.969）、0.793（95%CI：0.694-0.893）和0.728（95%CI：0.614-0.843），差异有统计学意义（P<0.05）。根据约登指数，最佳截断值分别为IL-6 = 3.775 ng/L（敏感性68.1%，特异性68.4%）、CRP = 6.650 mg/L（敏感性60.6%，特异性68.4%）和TNF-α = 0.666（敏感性60.6%，特异性71.1%）。
我们发现DII与儿童TS的严重程度、复发情况及炎症水平之间存在一定相关性。合理减少促炎食物的摄入量可能有助于降低TS儿童疾病进展的风险。
