Objective: To investigate the relationship between gastrointestinal disorders (GID) and core symptoms or behavioral problems among the children with autism spectrum disorder (ASD) . Method: Totally 328 children with ASD and 202 normal controls were enrolled in this cross-sectional study from August 2013 to October 2016. The information about the gastrointestinal disorders, behavioral and emotional problems was collected by using questionnaires. Childhood Autism Rating Scale (CARS), Autism Behavior Checklist (ABC) were used to assess the core symptoms of the children with ASD. Neurodevelopmental status was evaluated with Gesell Developmental Scale (GDS). These variables were analyzed by using student's t-test and chi-square test. Result: The prevalence of GID was significantly higher in the children with ASD than in the normally developing children (49.4% (162/328) vs.25.7% (52/202), χ(2)=29.039, P=0.000), especially the symptoms of constipation (33.2% (109/328) vs. 13.9% (28/202)), diarrhea (9.5%(31/328) vs. 1.5% (3/202)), nausea and vomiting (9.5% (31/328) vs. 3.5% (7/202)), and foul defecation (16.5% (54/328) vs. 5.0% (10/202)) (all P<0.05). Among the ASD children, the prevalence of GID was similar between male and female (46.7% (133/285) vs. 46.5%(20/43), χ(2)=0.006, P=0.938), as well as among all age groups (χ(2)=1.907, P=0.862). There was no significant difference in scores of GDS in the ASD children with or without GID (all P>0.05). Compared with ASD children without GID (n=166), the ASD children with GID (n=162) got higher scores in the "Body and Object Use" of ABC scale ( (16.4±9.3) vs. (12.3±6.7) scores, t=2.258, P=0.028), and had more emotional problems (63.6% (103/162) vs. 49.4% (82/166), χ(2)=6.707, P=0.010). Moreover, the score of behavior problems questionnaire was higher in the ASD children with GID ( (35.3±16.8) vs. (16.1±13.6) scores, t=5.748, P=0.000). Conclusion: Children with ASD have higher risk of GID than the normal developing children. While the stereotyped behaviors, problem behaviors and emotional problems are severer in the ASD children with GID. Hence, it is important to provide comprehensive treatment and management for these groups of children.
目的： 探讨孤独症谱系障碍(ASD)患儿胃肠道症状的发生情况及其与核心症状和问题行为的关系。 方法： 本研究为现况调查，依据精神疾病诊断及统计手册第五版(DSM-5)诊断标准，纳入2013年8月至2016年10月在重庆医科大学附属儿童医院发育与行为中心就诊和重庆市多家特殊训练机构的328例ASD患儿及202名正常儿童作为对照组，采用问卷调查儿童胃肠道症状和行为问题发生情况，采用儿童孤独症评定量表（CARS）、孤独症儿童行为检查量表（ABC）、Gesell发育量表对ASD患儿进行症状及智力发育评估，采用t检验和χ(2)检验分析ASD患儿胃肠道症状与行为表现。 结果： ASD组胃肠道症状总检出率明显高于正常对照组[49.4%(162/328)比25.7%(52/202)，χ(2)=29.039，P=0.000]，并且便秘[33.2%(109/328)比13.9%(28/202)]、腹泻[9.5%(31/328)比1.5%(3/202)]、恶心呕吐[9.5%(31/328)比3.5%(7/202)]和大便恶臭[16.5%(54/328)比5.0%(10/202)]检出率均明显高于对照组（P均<0.05）。男性和女性ASD患儿胃肠道症状检出率分别为46.7%（133/285）和46.5%(20/43)，差异无统计学意义（χ(2)=0.006，P=0.938）。不同年龄ASD患儿胃肠道症状检出率的组间差异无统计学意义(χ(2)=1.907，P=0.862)。将ASD患儿根据胃肠道症状发生情况分为胃肠道症状阳性组（162例）和胃肠道症状阴性组（166例）,两组Gesell发育量表评分差异无统计学意义(P均>0.05）。与胃肠道症状阴性组相比，胃肠道症状阳性组在ABC量表躯体运动（B）方面得分明显较高[（16.4±9.3）比（12.3±6.7）分，t=2.258，P=0.028],情绪问题检出率明显较高[63.6%（103/162）比49.4%（82/166），χ(2)=6.707，P=0.010]，行为问题评分明显高于胃肠道症状阴性组[(35.3±16.8)比(16.1±13.6)分，t=5.748，P=0.000]。 结论： ASD患儿的胃肠道症状发生率较正常儿童高，有胃肠道症状的ASD患儿具有更严重的重复刻板行为、问题行为及情绪问题，提示临床干预中ASD患儿的胃肠道问题不容忽视，多学科综合治疗对ASD患儿的康复具有重要意义。.
Keywords: Autism disorder; Behavior; Child; Gastrointestinal tract.