孤独症谱系障碍儿童脑白质纤维两年随访研究

发布时间：2018-06-17 04:28

本文选题：孤独症谱系障碍 + 脑白质　；参考：《南京医科大学》2017年硕士论文

【摘要】：[引言]孤独症谱系障碍(Autism Spectrum Disorder,ASD)是一种起病于儿童早期的神经发育障碍,其核心临床表现是社会交流障碍和局限、刻板的兴趣及行为。已有研究显示ASD患儿在儿童期、青少年期及成人期脑白质纤维束的完整性存在异常,但多数研究为横断面研究,纵向观察研究很少,尤其缺乏从ASD起病初期即开始的随访性研究。[目的]本研究选取71例2～3岁ASD及年龄、智能相匹配的发育迟缓(Developmental Delay,DD)儿童为研究对象,对比分析入组时两组被试脑白质主要纤维束的完整性上的差别及其与临床症状之间的相关性;再通过两年的随访,对比观察ASD组及DD组儿童两年间白质纤维束完整性的变化,以期发现ASD患儿脑白质主要纤维束发育轨迹的异常。[方法]运用儿童孤独症评定量表(Childhood Autism Rating Scale,CARS)、孤独症诊断访谈修订版(Autism Diagnoses Interview-Revised,ADI-R)、孤独症疗效评估(Autism Treatment Evaluation Checklist,ATEC)等评估工具对 40 名 ASD组及31名DD组儿童进行第一次临床心理评估,同时进行T1加权三维磁共振成像(Magnetic Resonance Imaging,MRI)和弥散张量成像(Diffusion Tensor Imaging,DTI)扫描,随访两年后重新评估并完成第二次核磁共振扫描。应用基于感兴趣区(Region of Interest,ROI)的方法对两组被试的脑影像学数据进行分析,横向比较两组被试在两个年龄段时脑白质重要纤维束结构完整性的差异,主要观察指标为19条纤维束(21个ROI)的平均各向异性分数(Fraction Anisotropy,FA),然后进一步分析ASD组各条纤维束FA值的变化与临床特征(CARS量表总分、ADI-R和ATEC量表的各个分量表分)之间的相关性。[结果]1.在2～3岁时,与DD组相比ASD组21个感兴趣区的白质纤维束的平均FA值差异均无显著性(p均0.05);ASD组21个感兴趣区的纤维束的FA值与临床症状的相关分析显示:ATEC量表的总分与右侧内囊前支的FA值负相关(r=-0.343,p=0.041);ATEC 量表的语言分量表分与总胼胝体(r=-0.347,p=0.038)、胼胝体膝部(r=-0.358,p=0.032)、右侧内囊前支(r=-0.351,p=0.036)、左侧内囊(r=-0.367,p=0.028)、左侧扣带回(r=-0.338,p=0.043)、左侧钩束、(r=-0.337,p=0.044)以及左侧额枕下束(r=-0.368,p=0.027)的平均FA值呈负相关;ATEC量表的社交分量表分与右侧内囊(r=-0.355,p=0.033)和右侧内囊后支(r=-0.362,p0.030)负相关;CARS量表总分及ADI-R量表的各分量表分与ASD组21个感兴趣区纤维束的FA值之间无相关性(p均0.05)。2.在4～5岁时,与DD组相比ASD组儿童总胼胝体、胼胝体膝部、双侧钩束、左侧扣带束、双侧内囊、右侧内囊后支、左侧内囊前支及右侧下纵束的FA值降低,差异具有显著性(p均0.05)。ASD组21个感兴趣区纤维束的FA值与临床症状的相关分析显示:ATEC量表总分与右侧弓状束的FA值正相关(r=0.370,p=0.029);ATEC量表社交分量表分与左侧弓状束的FA值正相(r=0.362,p=0.033);ATEC量表感知觉分量表分与左侧额枕下束的FA值负相关(r-0.376,p=0.026);ADI-R量表起病的项目分与左侧弓状束的FA值正相关(r=0.482,p=0.030);ASD组CARS量表总分及其他ADI-R量表的各分量表分与21个感兴趣区纤维束的FA值与之间的无相关性(p均0.05)。3.对比分析ASD组两年间21个感兴趣区纤维束的FA值的变化结果发现,除胼胝体压部外其余的纤维束的FA值两年后均增大,差异有显著性(p均0.05)。[结论]在2～5岁期间ASD患儿脑白质重要纤维束完整性的受损程度随着年龄的增加而增加,且与核心临床症状相关。
[Abstract]:[introduction] Autism Spectrum Disorder (ASD) is a kind of early childhood neurodevelopmental disorder. Its core clinical manifestations are social communication disorders and limitations, stereotyped interest and behavior. The study shows that the integrity of the white matter fiber bundles in children with ASD in childhood, adolescence and adult stage is abnormal, but there is an abnormality in the integrity of the white matter fiber bundles in childhood, adolescence and adult. Most studies are transect studies, and there are few longitudinal observation studies, especially a follow-up study that begins at the beginning of the onset of ASD. [Objective] this study selected 71 children aged 2~3 years and age ASD and age, Developmental Delay, DD children as the research object, and compared and analyzed the main fibrous bundle of white matter in the two groups. The difference in integrity and its correlation with clinical symptoms; and after two years' follow-up, the changes in the integrity of white matter fiber bundles in ASD and DD children were observed for two years, in order to find out the abnormal development of the main bundle of white matter in children with ASD. [Methods] the children autism Assessment Scale (Childhood Autism Rating Scale) was used. CARS), Autism Diagnoses Interview-Revised (ADI-R), the evaluation of autism efficacy assessment (Autism Treatment Evaluation Checklist, ATEC), the first clinical psychological assessment of 40 ASD and 31 children of DD groups. MRI) and diffusion tensor imaging (Diffusion Tensor Imaging, DTI) scan, reassessing and completing second NMR scans two years later. Using a method based on the region of interest (Region of Interest, ROI), the brain imaging data of the two groups were analyzed, and the two groups were compared with the two age groups of the brain white matter fiber. The difference in the integrity of the bundle structure was the main observation index of the average anisotropic fraction (Fraction Anisotropy, FA) of 19 fiber bundles (21 ROI), and then further analyzed the correlation between the changes in the FA value of the fiber bundles in the ASD group and the clinical features (the CARS scale, the ADI-R and the various components of the ATEC scale). [results]1. was at the age of 2~3, Compared with group DD, the average FA value of white matter fiber bundles in 21 regions of interest of ASD group was not significant (P 0.05). The correlation analysis between the FA value of fiber bundles in 21 regions of interest of ASD and clinical symptoms showed that the total score of the ATEC scale was negatively correlated with the FA value of the anterior branch of the right internal capsule (r= -0.343, p=0.041), and the language subscales of the ATEC scale and the total corpus callus. R=-0.347 (p=0.038), the genu of the corpus callosum (r=-0.358, p=0.032), the right anterior internal capsule (r=-0.351, p=0.036), the left internal capsule (r=-0.367, p=0.028), the left cingulate gyrus (r=-0.338, p=0.043), the left hook bundle, (r=-0.337, p=0.044), and the left inferior occipital bundle were negatively correlated; the social component and right of the scale The negative correlation between the lateral internal capsule (r=-0.355, p=0.033) and the right posterior branch of the internal capsule (r=-0.362, p0.030) was negative. There was no correlation between the total score of the CARS scale and the ADI-R scale and the FA of the 21 regions of the ASD group (P 0.05) (P 0.05).2. at the age of 4~5, compared with the DD group, the total corpus callosum of the ASD group, the corpus callosum, the bilateral hook bundle, the left cingulate bundle, The FA value of the lateral internal capsule, the right posterior branch of the internal capsule, the left anterior branch of the left inner capsule and the right inferior longitudinal fascicle was significant (P 0.05). The correlation analysis between the FA value of the fiber bundles in the 21 regions of interest of the.ASD group and the clinical symptoms showed that the total score of the ATEC scale was positively correlated with the FA value of the right arcuate bundle (r=0.370, p=0.029), and the social component of the ATEC scale and the left bow. The FA value of the bundle was positive (r=0.362, p=0.033); the sensory perception component of the ATEC scale was negatively correlated with the FA value of the left occipital tract (r-0.376, p=0.026); the item of the onset of the ADI-R scale was positively correlated with the FA value of the left arcuate bundle (r=0.482, p=0.030), and the components of the ASD group and the other 21 regions of interest zone fiber bundles. FA value and no correlation (P 0.05).3. comparison and analysis of the FA value of 21 region of interest zone fiber bundles in the ASD group two years later, the results showed that the FA value of the rest of the fiber bundles except the corpus callosum was increased two years later, the difference was significant (P all 0.05). [Conclusion] the damage process of the integrity of the important fibrous bundle of white matter in the 2~5 year old ASD children It increased with age and correlated with core clinical symptoms.
【学位授予单位】：南京医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R749.94

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