孤独症谱系障碍儿童功能性近红外光谱成像拓扑结构44例病例系列报告

Functional near-infrared imaging topology in 44 children with autism spectrum disorder:A case series report

背景青春期是大脑成熟和发育的重要时期。孤独症谱系障碍(ASD)青少年存在异常的前额叶和颞叶皮层激活和功能连通性,并可能与症状严重程度相关。目的图论研究ASD个体的脑网络拓扑属性的发育轨迹与年龄、认知和症状严重程度的相关性。设计病例系列报告。方法纳入符合DSM-Ⅳ-TR/DSM-Ⅴ/ICD-10/ICD-11诊断标准,并经ADOS-G和ADI-R评估证实的6~17岁、母语为普通话、右利手和全量表智商(FSIQ)≥70的ASD儿童青少年,采用连续波功能近红外光谱成像(fNIRS)设备采集8 min静息态信号,测量氧合Hb(HbO)、去氧Hb(HbR)和总Hb(HbT)的浓度。使用广义线性模型分析网络属性和年龄的关系;在控制了年龄的影响后,使用偏相关分析评价脑-行为关系。主要结局指标脑网络属性(全局效率、局部效率、中介中心度和度)。结果共纳入44例ASD儿童和青少年,年龄(9.5±1.5)岁,男40例,女4例。回归分析显示随年龄增大,HbO信号的全局效率下降(R ^(2)=0.233;P=0.026),局部效率保持稳定(R ^(2)=0.002,P>0.05);度和中介中心度在左额中回和额上回下降(通道3、4),在右颞上回和额下回上升(通道30、40、48)。偏相关分析结果示,认知能力主要与发育效应显著的脑区通道节点指标相关;ASD核心症状主要与发育效应不显著的脑区节点指标相关。结论自儿童期至青春期,ASD脑网络的功能整合下降,分化维持相近水平;前额叶网络的发育可能只与ASD个体的认知能力发育相关。

Background Adolescence is an important period of brain maturation and development,and adolescents with autism spectrum disorder(ASD)have atypical brain activation and functional connectivity in prefrontal and temporal cortex,which may be related to the symptom severity.Objective To examine the correlation between the development trajectories of the topological properties of the brain network and age,cognition and symptom severity in individuals with ASD via graph theory analysis.Design Case series report.Methods Children and adolescents with ASD who met the DSM-IV-TR/DSM-V/ICD-10/ICD-11 diagnostic criteria,and were confirmed by ADOS-G and ADI-R assessment were included.Inclusion criteria were as follows:age between 6 to 17 years old,first language being Mandarin Chinese,right-handed,and full-scale IQ(FSIQ)≥70.The 8-minute resting-state signals were collected by a continuous functional near-infared spectroscopy(fNIRS)device,measuring the concentration change of oxy-,deoxy-and total hemoglobin(HBO,HBR,HbT).The generalized linear model was applied to analyze the relationship between network properties and age.After the effect of age was controlled,partial correlation analyses were used to evaluate the brain-behavior relationships.Main outcome measures The topological properties of the brain network,including global efficiency,local efficiency,betweenness centrality and degree.Results A total of 44 children and adolescents with ASD(age 9.5±1.5 years,40 males and 4 females)were enrolled.Regression analysis showed that the global efficiency of HBO data decreased with age(R ^(2)=0.233,P=0.026),while the local efficiency remained stable(R ^(2)=0.002,P>0.05).The betweenness centrality and degree of the right superior temporal gyrus and inferior frontal gyrus were decreased(channel 3,4),while those of left middle and superior frontal gyrus were increased(channel 30,40,48).The topological properties of brain regions showed that significant age effects were related to the cognitive ability,while the core symptoms of ASD were related to the nodal metrics of brain regions that showed nonsignificant development.Conclusion Results suggested a decreased functional integration and similar segregation development of brain network in ASD from childhood to adolescence.Current research also implied that the development of prefrontal network may be only related to the development of cognition ability of participants with ASD.