注意缺陷多动障碍患儿静息态功能磁共振百分率振幅和度中心性研究

Percentage amplitude and degree centrality of resting-state functional magnetic resonance imaging in children with attention deficit hyperactivity disorder

目的探讨注意缺陷多动障碍(attention deficit hyperactivity disorder,ADHD)患儿执行功能缺陷与静息态脑功能影像特征之间的关系。方法 2018年3月至2020年1月选取40名ADHD患儿(ADHD组)及37名正常发育儿童(TD组)。所有被试进行执行功能评估及静息态功能磁共振(rs-fMRI)扫描,以百分率振幅(percent amplitude of fluctuation,PerAF)及度中心性(degree centrality,DC)作为rs-fMRI测量指标。ADHD患儿家长填写症状评估量表。比较两组儿童执行功能及脑自发活动的差异,并分析ADHD脑功能异常与症状及执行功能的相关性。结果 (1)ADHD组双侧颞下回(x,y,z=-57,-30,-33,t=6.22;x,y,z=48,-24,-36,t=8.27)、左侧直回(x,y,z=-3,30,-24,t=7.56)PerAF值较TD组增高(FDR校正,P<0.01,团块大小≥10体素),而双侧额上回(t=-5.07,t=-6.96)、左内侧额上回(t=-5.34)、中央前回(t=-6.31)、缘上回(t=-5.52)、苍白球(t=-6.40)及右侧三角部额下回(t=-5.13)、角回(t=-6.43)和楔前叶(t=-5.26)降低(FDR校正,P<0.01,团块大小≥10体素)。(2)ADHD组左侧额上回(x,y,z=0,-9,78,t=5.21)及右侧岛叶(x,y,z=33,18,12,t=4.58)DC值较TD组增高(FDR校正,P<0.01,团块大小≥10体素),而双侧颞下回(t=-4.65,t=-6.38)、颞中回(t=-5.85,t=-4.92),右侧颞上回(t=-5.27),左侧眶部额上回(t=-5.19)、岛盖部额下回(t=-4.68)、岛叶(t=-5.49)和缘上回(t=-5.11)降低(FDR校正,P<0.01,团块大小≥10体素)。(3)ADHD组左侧缘上回PerAF值与倒背数字广度(r=0.68,P<0.01)、Stroop甲表正确读数(r=0.46,P=0.04)呈正相关;右侧三角部额下回PerAF值与持续错误数呈负相关(r=-0.45,P=0.04);左侧颞下回PerAF值与Stroop甲表正确读数(r=0.46,P=0.04)、乙表正确读数(r=0.54,P=0.02)呈正相关。结论 ADHD患儿多个脑区自发活动异常,且脑区功能异常与其执行功能缺陷存在相关性。

Objective To investigate the characteristics of resting-state functional imaging in children with attention deficit hyperactivity disorder(ADHD),and explore the correlation between the executive functions and resting-state functional magnetic resonance imaging(rs-fMRI).Methods From March 2018 to January 2020,40 children with ADHD(ADHD group)and 37 typical developed children(TD group)were selected.All the subjects were investigated by a set of tools for executive function and experienced the rs-fMRI scan.Percent amplitude of fluctuation(PerAF)and degree centrality(DC)was used to analyze fMRI data in resting state.Parents of ADHD children completed symptom assessment scale.The differences of executive function and spontaneous brain activity between the two groups were compared,and the correlation between brain dysfunction and symptoms and executive function of ADHD was analyzed.Results(1)Compared with TD group,PerAF value of ADHD group increased in bilateral inferior temporal gyrus(x,y,z=-57,-30,-33,t=6.22;x,y,z=48,-24,-36,t=8.27)and left rectus(x,y,z=-3,30,-24,7.56)(FDR corrected,P<0.01,cluster size≥10 voxel),while decreased in bilateral superior frontal gyrus(t=-5.07,t=-6.96),left medial superior frontal gyrus(-5.34),left precentral gyrus(t=-6.31),left supramarginal gyrus(t=-5.52),left pallidum(-6.40),right triangular inferior frontal gyrus(t=-5.13),right angular(-6.43)and right precuneus(t=-5.26)(FDR corrected,P<0.01,cluster size≥10 voxel).(2)Compared with the TD group,DC value of ADHD group increased in left superior frontal gyrus(x,y,z=0,-9,78,^=5.21)and right insula(x,y,z=33,18,12,4.58)(FDR corrected,P<0.01,cluster siz≥10 voxel),while decreased in bilateral inferior temporal gyrus(t=-4.65yt=-6.38),bilateral middle temporal gyrus(t=-5.85,t=-4.92),right superior temporal gyrus(t=-5.27),left orbital superior frontal gyrus(t=-5.19),left pars opercularis of the inferior frontal gyrus(t=-4.68),left insula(t=-5.49)and left supramarginal gyrus(t=-5.11)(FDR corrected,P<0.01,cluster size≥1O voxel).(3)In ADHD group,there was a positive correlation between PerAF value of left supramarginal gyrus and the correct number in test A of Stroop test(r=0.46,P=0.04)and the backward digit span(WISC-IV)(r=0.68,P<0.01);PerAF value of right triangle inferior frontal gyrus was negatively correlated with sustained error number(WCST)(r=-0.45,P=0.04);PerAF value of left inferior temporal gyrus was positively correlated with the correct number in test A of Stroop test(r=0.46,P=0.04)and the correct number in test B of Stroop test(r=0.54,P=0.02).Conclusion Children with ADHD have abnormal spontaneous activities in multiple brain regions,which correlated with the deficits of executive functions.