孤独症患儿神经连接异常的影像特征

doi:10.3969/j.issn.1006-9771.2020.04.016

《中国康复理论与实践》 ›› 2020, Vol. 26 ›› Issue (4): 472-478.doi: 10.3969/j.issn.1006-9771.2020.04.016

孤独症患儿神经连接异常的影像特征

姚滔涛^1,²,陈卓铭³(),张书晨⁴

1.广州中医药大学针灸康复临床医学院,广东广州市 510405
2.广州中医药大学第一附属医院康复中心,广东广州市510405
3.暨南大学附属第一医院康复科,广东广州市 510632
4.盐城市第一人民医院影像科,江苏盐城市 224001

收稿日期:2019-06-20 修回日期:2019-07-19 出版日期:2020-04-25 发布日期:2020-04-27
通讯作者: 陈卓铭 E-mail:tchzm@21cn.com
作者简介:姚滔涛(1986-),女,汉族,广东罗定市人,博士研究生,主治医师,主要研究方向：神经康复。
基金资助:
1.国家自然科学基金项目(81372113);2.教育部人文社会科学重点研究基地重大项目(1002879)

Imaging Features of Abnormal Neural Connectivity in Autistic Children

YAO Tao-tao^1,²,CHEN Zhuo-ming³(),ZHANG Shu-chen⁴

1. College of Acupuncture and Rehabilitation, Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, China
2. Rehabilitation Center, the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong 510405, China
3. Department of Rehabilitation Medicine, the First Affiliated Hospital, Jinan University, Guangdong 510632, China
4. Imaging Department, the First People's Hospital of Yancheng, Yancheng, Jiangsu 224001, China

Received:2019-06-20 Revised:2019-07-19 Published:2020-04-25 Online:2020-04-27
Contact: CHEN Zhuo-ming E-mail:tchzm@21cn.com
Supported by:
National Natural Science Foundation of China(81372113);Major Project of the Key Research Base of Humanities and Social Sciences of the Ministry of Education(1002879)

摘要/Abstract

摘要：

目的联合应用弥散张量成像(DTI)和磁共振波谱(MRS)技术分析孤独症患儿大脑白质的结构和功能,探讨孤独症患儿神经连接异常的影像学特征。方法对符合入选标准的2~9岁孤独症患儿(孤独症组,n= 14)和健康儿童(对照组,n= 8)分别进行DTI和MRS检测,以双侧额叶、胼胝体膝部及压部、海马、小脑白质为感兴趣区,利用GEAW 4.2工作站的Functool 2.6软件分别对DTI及MRS数据进行后处理分析,分别记录DTI的各向异性分数(FA)、表观弥散系数(ADC),MRS的代谢物N-乙酰天门冬氨酸(NAA)、胆碱(Cho)、肌酐(Cr)绝对浓度以及NAA/Cr、Cho/Cr比值。结果与对照组相比,孤独症组左海马FA降低(F= 5.922, P = 0.033),左右海马Cr降低(F> 4.715,P < 0.05)。孤独症组左侧胼胝体膝部FA低于右侧( F = -2.335, P = 0.042),左侧胼胝体压部ADC明显高于右侧(F = 3.520, P < 0.01);左侧额叶NAA、Cho、Cr绝对浓度(| t| > 2.648, P < 0.05),胼胝体压部NAA绝对浓度( t= -3.076, P = 0.009),小脑Cho/Cr均低于右侧(t= -2.225, P = 0.044)。对照组左右半球相对脑区DTI和MRS检测值均无显著性差异(P > 0.05)。结论孤独症患儿额叶、海马、小脑、胼胝体膝部及压部存在局部代谢或功能的异常,提示孤独症患儿可能存在半球内尤其左侧大脑半球内神经连接不足,半球间神经连接不足。

关键词: 孤独症, 神经连接, 弥散张量成像, 磁共振波谱

Abstract:

Objective To analyze the structure and function of white matter in autistic children by using diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS), to explore the imaging features of abnormal neural connectivity in children with autism.Methods Autism group (n = 14) and control group (n= 8), aged two to nine years, underwent DTI and MRS scan. Bilateral frontal lobe, hippocampus, genu and splenium of corpus callosum and cerebellum white matter were selected as regions of interest. The data of DTI and MRS were processed by Functool 2.6 software of GEAW4.2 workstation. The fractional anisotropy (FA) and apparent diffusion coefficient (ADC) of DTI, the absolute concentrations of N-acetylaspartate (NAA), choline (Cho), creatinine (Cr) and the ratios of NAA/Cr and Cho/Cr were recorded respectively.Results Compared with the control group, the FA of left hippocampus (F= 5.922, P = 0.033) and the absolute concentration of Cr in left and right hippocampus (F> 4.715,P < 0.05) decreased significantly in the autism group. The FA was lower in left corpus callosum genu than in the right one ( F = -2.335, P = 0.042), and the ADC was higher in left corpus callosum splenium than in the right one (F = 3.520, P < 0.01) in the autism group. The absolute concentration of NAA, Cho and Cr in left frontal lobe (| t| > 2.648, P < 0.05), the absolute concentration of NAA in left corpus callosum splenium ( t= -3.076, P = 0.009) and Cho/Cr in left cerebellum (t= -2.225, P = 0.044) were significantly lower than those in the right cerebral hemisphere in the autism group. The DTI and MRS indexes were not different between left and right hemispheres in the control group (P > 0.05). Conclusion Abnormal metabolite or functional alternations were found in the frontal lobe, hippocampus, cerebellum and the genu and splenium of the corpus callosum in autistic children, suggesting underconnectivity intra- or inter-hemispheric neural, especially in left hemisphere.

Key words: autism, abnormal neural connectivity, diffusion tensor imaging, magnetic resonance spectroscopy

中图分类号:

R749.94

姚滔涛,陈卓铭,张书晨. 孤独症患儿神经连接异常的影像特征[J]. 《中国康复理论与实践》, 2020, 26(4): 472-478.

YAO Tao-tao,CHEN Zhuo-ming,ZHANG Shu-chen. Imaging Features of Abnormal Neural Connectivity in Autistic Children[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2020, 26(4): 472-478.

图/表 5

表1

表2

表3

两组相应脑区代谢物比较"

部位	代谢物	对照组		孤独症组		F值^a	P值^a	F值^b	P值^b	t值^c	P值^c	t值^d	P值^d
部位	代谢物	左	右	左	右	F值^a	P值^a	F值^b	P值^b	t值^c	P值^c	t值^d	P值^d
额叶	NAA(mmol/kg)	10915.50±2304.02	11260.50±2374.15	7716.00±5290.04	8425.71±5854.92	1.100	0.308	0.866	0.364	-2.021	0.083	-2.807	0.015
	Cho(mmol/kg)	8662.50±1931.34	8784.88±2263.00	5729.43±4493.54	6494.71±4534.03	0.882	0.187	0.847	0.370	-0.533	0.610	-2.804	0.015
	Cr(mmol/kg)	5984.00±1163.30	5929.00±1506.78	4224.00±2595.13	4735.57 ±2818.30	2.123	0.162	0.613	0.444	0.206	0.843	-2.648	0.020
	NAA/Cr	1.758±0.155	1.927±0.249	1.780±0.247	1.780±0.401	0.415	0.523	0.416	0.527	-1.981	0.088	0.005	0.996
	Cho/Cr	1.472±0.368	1.507±0.354	1.305±0.274	1.349 ±0.200	0.619	0.442	0.839	0.372	-0.526	0.615	-0.609	0.553
海马	NAA(mmol/kg)	6705.00±1459.01	7662.00±2789.01	5160.5±2070.00	5555.14±2480.99	2.978	0.102	4.029	0.060	-1.034	0.335	-1.123	0.282
	Cho(mmol/kg)	6674.25±1021.25	6954.75±1387.34	5107.36±2236.16	5254.07±2304.16	3.033	0.099	3.272	0.087	-0.675	0.521	-0.695	0.499
	Cr(mmol/kg)	4955.50±1403.07	4972.00±1525.66	3424.07±1394.31	3474.43±1641.15	6.502	0.020	4.715	0.044	-0.041	0.968	-0.184	0.857
	NAA/Cr	1.397±0.273	1.547±0.317	1.610±0.517	1.640±0.392	1.621	0.219	0.210	0.652	-0.795	0.453	-0.236	0.817
	Cho/Cr	1.423±0.368	1.466±0.359	1.566±0.500	1.597±0.467	0.785	0.387	0.632	0.437	-0.456	0.662	-0.268	0.793
小脑	NAA(mmol/kg)	8600.00±4215.58	9866.00±4509.24	5305.71±6420.88	5803.21±6493.00	0.905	0.356	1.592	0.225	-2.347	0.066	-1.417	0.180
	Cho(mmol/kg)	8138.17±3011.96	8046.50±3551.14	4482.71±5795.56	4785.79±5463.38	1.325	0.267	1.333	0.265	0.153	0.885	-1.120	0.283
	Cr(mmol/kg)	7206.83±2751.87	7434.17±2739.97	4051.93±4554.73	3367.57±3830.18	1.815	0.197	4.251	0.056	-0.361	0.733	2.032	0.063
	NAA/Cr	0.887±0.600	0.967±0.610	1.054±0.636	1.565±1.365	0.380	0.545	1.153	0.297	-1.202	0.268	-1.639	0.125
	Cho/Cr	0.869±0.573	0.793±0.499	0.864±0.531	1.189±0.783	0.020	0.890	1.455	0.243	0.877	0.410	-2.225	0.044
胼胝体膝部	NAA(mmol/kg)	3900.00±4348.98	4232.00±4872.09	3465.43±5067.72	3769.71±5460.74	0.135	0.718	0.150	0.704	-1.023	0.353	-1.411	0.182
	Cho(mmol/kg)	3818.83±4298.59	3976.50±4589.77	3559.29±5370.07	3667.71±5341.55	0.063	0.805	0.079	0.783	-0.776	0.473	-0.764	0.458
	Cr(mmol/kg)	2035.00±2386.77	2319.17±2699.86	2203.93±3184.85	2218.86±3076.47	<0.001	0.994	0.051	0.825	-1.032	0.349	-0.182	0.858
	NAA/Cr	0.766±1.106	0.708±1.009	0.667±0.807	0.694±0.868	0.348	0.563	0.114	0.739	1.353	0.218	-0.581	0.571
	Cho/Cr	0.757±1.110	0.667±0.953	0.655±0.808	0.676±0.836	0.266	0.612	0.045	0.834	1.360	0.216	-0.734	0.476
胼胝体压部	NAA(mmol/kg)	10051.33±5322.88	10752.00±5691.77	7377.57±7158.37	8255.14±7925.93	1.389	0.257	1.791	0.201	-1.934	0.111	-3.076	0.009
	Cho(mmol/kg)	6538.33±3509.77	6992.33±3793.72	5224.21±4929.72	5637.50±5309.14	1.109	0.309	1.224	0.286	-1.332	0.240	-1.539	0.148
	Cr(mmol/kg)	4563.67±2259.11	4686.00±2354.55	3311.00±3246.49	3501.14±3533.40	1.757	0.205	1.868	0.192	-1.021	0.354	-0.934	0.367
	NAA/Cr	1.401±1.172	1.428±1.198	1.294±1.192	1.393±1.274	0.004	0.952	0.005	0.943	-0.374	0.719	-1.079	0.300
	Cho/Cr	1.013±0.910	0.936±0.806	0.936±0.873	0.978±0.928	0.032	0.860	0.076	0.786	0.896	0.400	-0.478	0.641

表3

图1

图2

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组别	n	性别(男/女,n)	年龄(岁)	头围(cm)
对照组	8	6/2	3.7±2.2	50.4±1.4
孤独症组	14	12/2	4.4±1.9	51.1±1.6
χ²/t值		0.393	0.809	1.033
P值		0.602	0.428	0.314

部位	代谢物	对照组		孤独症组		F值^a	P值^a	F值^b	P值^b	t值^a	P值^a	t值^b	P值^b
部位	代谢物	左	右	左	右	F值^a	P值^a	F值^b	P值^b	t值^a	P值^a	t值^b	P值^b
额叶	FA	0.298±0.038	0.347±0.022	0.272±0.108	0.284±0.129	0.464	0.510	0.883	0.368	-1.641	0.199	-0.857	0.411
额叶	ADC	8.715±0.319	8.552±0.167	8.912±0.581	8.985±0.472	0.553	0.473	2.423	0.148	0.689	0.540	-0.372	0.718
海马	FA	0.503±0.032	0.489±0.042	0.396±0.074	0.408±0.076	5.922	0.033	4.022	0.070	0.998	0.392	-0.511	0.621
海马	ADC	9.340±0.423	8.962±0.141	9.034±0.729	9.000±0.539	0.480	0.503	0.090	0.770	1.433	0.247	0.135	0.895
小脑	FA	0.395±0.120	0.406±0.107	0.392±0.158	0.439±0.127	0.002	0.964	0.181	0.679	-0.820	0.472	-1.621	0.136
小脑	ADC	8.797±0.764	8.645±0.774	7.988±0.761	8.071±0.751	3.227	0.100	0.747	0.406	2.845	0.065	-0.768	0.460
胼胝体膝部	FA	0.642±0.143	0.619±0.138	0.478±0.209	0.547±0.223	1.423	0.258	0.213	0.654	1.975	0.143	-2.335	0.042
胼胝体膝部	ADC	8.675±0.364	8.490±0.193	8.554±2.874	8.321±2.808	0.009	0.925	0.013	0.913	0.871	0.448	1.383	0.197
胼胝体压部	FA	0.679±0.171	0.702±0.138	0.656±0.103	0.646±0.105	0.024	0.881	0.732	0.411	-0.542	0.625	0.354	0.730
胼胝体压部	ADC	9.472±0.217	9.133±0.365	9.607±0.256	9.235±0.473	0.881	0.368	0.258	0.621	2.205	0.115	3.520	0.006

孤独症患儿神经连接异常的影像特征

Imaging Features of Abnormal Neural Connectivity in Autistic Children

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