儿童孤独症的临床及脑影像学研究

Clinical Features and Brain Image of Children with Autism

目的 :对儿童孤独症的临床特征及脑影像学进行研究。方法 :病例确诊依据“中国精神疾病分类方案与诊断标准 (修订第二版 )”中有关孤独症的诊断标准。临床资料收集来源于病史、躯体检查及精神状况检查。用单光子发射CT检查患儿的脑影像。结果 :共确诊患儿 86例 (男 75 ,女 11) ,占精神专科门诊人数的 3 %。他们在孕产期有明确并发症的占 2 7% ,4人有阳性家族史。言语发育和交往障碍是所有患儿的核心症状 ,多数有多动表现 ,部分患儿还伴有明显的情绪及其它行为障碍。做过头部CT或 /和MRI检查的 44人中 ,42例报告无异常。 32例完成脑SPECT检查 ,其中 2 4人 (男 2 3 ,女 1)存在局部放射性分布减低 ,这种异常主要见于大脑皮质的额叶和颞叶 ,以左侧额叶最为常见。结论 :SPECT在反映儿童孤独症的病理生理方面比结构性脑成像更为敏感。本病患儿大脑皮质额叶和颞叶存在局部血流灌注或 /和细胞功能障碍 。

Objective: To study the clinical features and brain image of children with autism Method: Cases were identified according to the diagnostic criteria of autism as defined in CCMD-2-R Clinical data including CT and MRI report were collected based on case history and structured somatic and mental examinations The technique of SPECT was used to investigate the functional brain image of patients Result: 75 boys and 11 girls aged 2 1 to 13(5 1±2 2)years diagnosed as autism in a out-patient department of child psychiatry from 1996 to 1999 were collected More than one forth of them experienced some complications in the course of pregnancy or deliver, 4 had positive family history In addition to the disturbance of language development and social communication, which were seen in all of the patients, most of them appeared to be hyperactive, some also displayed severe emotion and other behavior problems Among the 44 patients who had previously carried out CT and/or MRI scans, 42 had a normal result Twenty four of the 32 autistic children completed brain SPECT showed reduction of local radiation, that were mainly seen in frontal or temporal lobes of the cortex, with the left frontal lobe being more common Conclusion: Children with autism are not uncommon as thought before in China Majority of them exist reduction of regional blood flow and/or cell dysfunction in the brain cortex