学龄前期及学龄期孤独症谱系障碍儿童脑结构异常的研究

Abnormal brain structure in preschool and school-aged children with autism spectrum disorder

目的研究学龄前期及学龄期孤独症谱系障碍(ASD)儿童脑结构异常的发生率及类型。方法选取上海市74 252名3~12岁学龄前期及学龄期儿童为研究对象。通过问卷调查方式收集每位儿童的基本信息,家长及教师根据儿童实际情况填写儿童社会交往量表(SCQ)。针对所有高度可疑ASD儿童由专科医师根据DSM-5诊断标准进行确诊,同时根据家长意愿完善颅脑MRI检查。结果学龄前期及学龄期儿童ASD总体发病率为2.59‰(192/74 252)。共收集到73名ASD儿童和185名正常儿童的颅脑MRI资料,ASD儿童中脑结构异常率为55%(40/73),主要异常类型为一侧或双侧脑室扩大(80%,32/40)及一侧或双侧额颞部脑沟加深(30%,12/40)。ASD儿童双侧侧脑室白质信号降低、一侧或双侧额颞脑沟加深比例高于正常儿童(P<0.05)。结论学龄前期及学龄期ASD儿童中脑结构异常发生率高,主要结构异常为一侧或双侧脑室扩大及一侧或双侧额颞脑沟加深,推测其脑结构的异常可能与ASD的发病相关,关于发生异常的脑区结构与ASD儿童的症状之间的关系有待进一步研究确证。

Objective To investigate the prevalence and type of abnormal brain structure in preschool and school-aged children with autism spectrum disorder(ASD).Methods A total of 74252 preschool and school-aged children aged 3-12 years in Shanghai were enrolled as subjects.A questionnaire survey was performed to collect basic information,and their parents and teachers completed the Social Communication Questionnaire(SCQ)based on the children's conditions.ASD was diagnosed by specialist physicians according to the DSM-5 criteria.Brain magnetic resonance imaging(MRI)was performed according to their parents'desires.Results The overall prevalence rate of ASD was 2.59‰(192/74252)in the preschool and school-aged children.Brain MRI data were collected from 73 children with ASD and 185 healthy children.Among the 73 children with ASD,40(55%)had abnormal brain structure,and the most common types were unilateral or bilateral ventriculomegaly in 32 children(80%)and unilateral or bilateral deep frontotemporal sulci in 12 children(30%).Children with ASD showed lower white matter signal in bilateral ventricular and unilateral or bilateral deep frontotemporal sulci,compared to their normal peers(P<0.05).Conclusions There is a high prevalence rate of abnormal brain structure in preschool and school-aged children with ASD,with major types of unilateral or bilateral ventriculomegaly and unilateral or bilateral deep frontotemporal sulci.It is speculated that abnormal brain structure might be associated with the pathogenesis of ASD,and further studies are needed to clarify the association between abnormal brain structure and symptoms in children with ASD.