2～3岁孤独谱系障碍儿童突显网络的磁共振研究

Magnetic resonance imaging( MRI) study of the salience network in 2- 3 year-old children with autism spectrum disorder

目的：探讨2～3岁孤独谱系障碍（ASD）与发育迟缓（DD）儿童突显网络的结构差异.方法：对46名符合美国精神障碍诊断和统计手册第4版（修订版）（DSM-Ⅳ-TR）诊断标准的ASD和39例年龄、性别及发育商匹配的DD儿童（对照组）进行磁共振（MRI）扫描,比较两组前扣带回、岛叶灰质体积和皮层厚度的差异,分析前扣带回与岛叶灰质体积的相关性.使用孤独症诊断访谈量表（修订版）（ADI-R）以及沟通及象征行为量表/发展概况表（CSBS-DP）评估两组儿童的临床症状,分析ASD临床症状与脑结构体积变化之间的相关性.结果：与对照组相比,ASD组左侧岛叶灰质体积、左尾部及左喙部扣带区灰质体积增大（均P ＜0.05）.两组儿童的前扣带回和岛叶皮层厚度差异均无统计学意义（均P＞0.05）.分别以年龄和全脑体积为协变量后ASD组左侧岛叶灰质体积[（7.1±0.6） cm3 vs.（6.7±0.8）cm3]、左尾部扣带区灰质体积[（1.9±0.4） cm3vs.（1.7±0.4） cm3]及左喙部扣带区灰质体积[（2.7±0.5） cm3 vs.（2.3±0.6） cm3]差异仍有统计学意义（均P＜0.05）.ADI-R及CSBS-DP评分与体积的相关分析表明,对照组“用物”分项的评分与右侧岛叶灰质体积（r =0.38,P＜0.05）呈正相关,其他相关系数无统计学意义.结论：与智能匹配的发育迟缓儿童相比孤独谱系障碍儿童突显网络的重要节点可能存在体积异常.

Objective： To investigate the difference of the salience network between 2 -3 years old children with autism spectrum disorder （ASD） and those with developmental delay （DD）. Methods： Forty-six autism spectrum disorder children aged 2 -3 years （case group） and 39 developmental delay children whose age, gender and developmental quotient matching with the ASD children （control group） were scanned by magnetic resonance imaging （MRI）. The diagnoses were made according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision （DSM-IV-TR） criteria. The two groups anterior cingulate, insula gray matter volume and brain cortical thickness were compared, and the correlation between the gray matter volume of anterior cingulateand insula were analyzed. All subjects were assessed the clinical symptoms with the Autism Diagnoses Interview- Revised （ADI-R）, Communication and Symbolic Behavior Scales-Developmental Profile （CSBS-DP）, and the correlation between clinical symptoms and brain structural volume changes were analyzed. Results： Compared with the control group, the gray matter volume in the left insula, caudal eingulate zone and rostral cingulate zone were larger in the ASD group （Ps 〈 0. 05）. There was no significant difference between the two groups on the brain cortical thickness in the anterior cingulate and insula （Ps 〉 0. 05）. With age and total brain volume controlled, the significant differences of the gray matter volume in the left insula [（7.1 ±0.6） cm3 vs. （6.7±0.80） cm3], left caudal cingu- late [（1.9±0.4） cm3 vs. （ 1.7±0.4） cm3] and left rostral cingulate [（2. 7±0. 5） cm3 vs. （2. 3 ±0. 6） cm3] still existed （Ps 〈 0.05）. There was no significant correlation between the two groups about the ADI-R scores and the gray matter volume in the anterior cingulate and insula. The using the items scores were positively correlated with the gray matter volume of the right insular cortex in the control group （r = 0. 38, P 〈 0. 05）. There were no correlations between CSBS-DP scores and the gray matter volume of insula and cingulate in the ASD group. Conclusion： These firdings show that compared with children with developmental delay, those with autism spectrum disorder may have abnormal brain volumes in the key nodes of the salience network.