目的 探讨孤独症谱系障碍(ASD)患儿与正常儿童脑白质连接的差异。方法 2017年9月至2018年7月,选取ASD患儿10例(ASD组)和正常儿童10例(对照组)。ASD组采用Gesell发展量表(GDS)评定发育商,并采用孤独症儿童心理教育评核第3版(PEP-3)进行评定。所有儿童均行MRI弥散张量成像(DTI)扫描,比较两组各向异性分数(FA)、轴向弥散系数(AD)、径向弥散系数(RD)和平均弥散系数(MD)差异;以及ASD组临床量表评分与DTI各参数行相关性分析。结果 与对照组相比,ASD组左侧小脑中脚、左侧胼胝体体部、左侧内囊后肢、双侧放射冠和双侧上纵束FA降低,左侧小脑中脚、左侧胼胝体体部及压部、双侧放射冠和双侧上纵束RD增高。智龄与左侧小脑中脚FA呈正相关(r = 0.686, P < 0.05),发育商与左侧放射冠(r = 0.720, P < 0.05)和左侧胼胝体压部(r = 0.744, P < 0.05) FA呈正相关,语言表达(r = 0.711, P < 0.05)和语言理解(r = 0.754, P < 0.05)与左侧胼胝体体部FA呈正相关,精细运动与左侧小脑中脚FA呈正相关(r = 0.723, P < 0.05),情感表达与左侧胼胝体体部RD呈负相关(r = -0.902, P < 0.05)。结论 ASD患儿脑白质发育异常,且与智力、发育和临床表现相关。
Objective To explore the central pathogenesis of autism spectrum disorder (ASD) by comparing the difference between children with ASD and typically developing children. Methods From September, 2017 to July, 2018, ten children with ASD (ASD group) and ten typically developing children (control group) were included. ASD group was assessed with Gesell Developmental Schedules (GDS) and Psychoeducational Profile-Third Edition (PEP-3). All the children accepted diffusion tensor imaging, and the differences in fraction anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD) and mean diffusivity (MD) between them were compared, and the correlation between abnormal data and the clinical scores was explored in ASD group. Results Compared with those in the control group, FA decreased in left middle cerebellar, left peduncle body of corpus callosum, left posterior limb of internal capsule, bilateral corona radiate and bilateral longitudinal fasciculus in ASD group; while RD increased in left middle cerebellar, left peduncle body and splenium of corpus callosum, bilateral corona radiata and bilateral longitudinal fasciculus. The mental age correlated with FA of left middle cerebellar (r = 0.686, P < 0.05), and the development quotient correlated with FA of left corona radiate (r = 0.720, P < 0.05) and left peduncle body of corpus callosum (r = 0.744, P < 0.05). The scores of Expressive Language (r = 0.711, P < 0.05) and Receptive Language (r = 0.754, P < 0.05) were correlated with FA of left peduncle body of corpus callosum, while the scores of Fine Motor were correlated with FA of left middle cerebellar (r = 0.723, P < 0.05). The scores of Affective Expression were correlated with RD of left peduncle body of corpus callosum (r = -0.902, P < 0.05). Conclusion There are developmental disorders of brain white matter in children with ASD, which may involve in mentality, development and clinical features.
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