本文關鍵詞： 孤獨譜系障礙 尾狀核體積 重復刻板行為 半自動勾畫法 自動分割法　出處：《南京醫(yī)科大學》2014年碩士論文　論文類型：學位論文

【摘要】：[引言] 孤獨譜系障礙(autism spectrum disorder, ASD)是一種起病于兒童早期的神經(jīng)發(fā)育障礙,重復刻板行為(restricted, repetitive behavior, RRB)是其核心癥狀之一。已有研究發(fā)現(xiàn)成年ASD患者的尾狀核體積存在異常增大且與RRB的嚴重程度相關,但幼兒期ASD尾狀核體積與RRB之間的關系如何仍需進一步研究。 [目的] 本研究選取2～3歲ASD以及發(fā)育遲緩(developmental delay, DD)兒童為研究對象,對比分析兩組被試尾狀核體積的差異,并進一步探討體積變化與RRB的特點及嚴重程度之間的相關性。同時在尾狀核體積計算方法學上擬比較半自動勾畫與軟件自動分割方法的優(yōu)劣。 [方法] 對66名ASD兒童和36名性別、年齡、智商與之相匹配的DD兒童采用T1-weight加權序列進行頭部的三維磁共振成像(magnetic resonance imaging,MRI)掃描,分別使用ITK-SNAP軟件半自動勾畫法和Freesurfer軟件自動分割法,計算兩組被試的尾狀核體積,并分別比較半自動勾畫以及軟件自動分割法所得ASD組與DD組的尾狀核體積。同時結合修訂版孤獨癥診斷訪談量表(Autism Diagnostic Interview-Revise, ADI-R)中高、低水平RRB分及RRB總分以及重復刻板行為量表-修訂版(Repetitivebehaviorscale-revised, RBS-R)各分量表分,進行尾狀核體積與RRB特征及嚴重程度的相關分析。 [結果] (1)兩組被試尾狀核體積比較：運用半自動勾畫法可得,ASD組的尾狀核 左側(3504.15±508.68mm3vs3206.60±490.68mm3, P=0.005).右側(3683.31±483.59mm3vs3313.07±453.24mm3, P=0.001)以及總體積(7187.46±959.00mm3vs6519.67±901.87mm3, P=0.001)較DD組顯著增大。在校正了ICV后,ASD組尾狀核的左側(P0.001)、右側(P=0.001)以及總體積(P0.001)較DD組仍增大,且差異更加顯著。Freesurfer軟件自動分割計算可見ASD組的尾狀核左側(3423.95±411.67mm3vs3212.97±405.23mm3, P=0.015)、右側(3543.98±396.30mm3vs3337.50±414.45mm3, P=0.015)以及總體積(6967.939±795.16mm3vs6550.47±792.09mm3, P=0.013)較DD組顯著增大；在校正了顱內(nèi)體積(intracranial volume, ICV)后,ASD組尾狀核左側(P0.001)、右側(P0.001)以及總體積(P0.001)較DD組仍增大,且差異更加顯著。 (2)尾狀核體積與RRB嚴重程度的相關分析：結果顯示,在ASD組,半自動勾畫法得到的尾狀核左側(r=0.359,P=0.004)、總體積(r=0.317,P=0.013)與ADI-R低水平RRB分呈顯著正相關；在校正ICV后,半自動勾畫法得到的尾狀核左側(r=0.417,P=0.001)、右側(r=0.296,P=0.025)總體積(r=0.372,P=0.004)以及軟件自動勾畫法得到的尾狀核左側(r=0.384,P=0.003)、右側(r=0.363,P=0.006)及總體積(r=0.385,P=0.003)均與ADI-R低水平RRB分呈顯著正相關；而兩種方法所得ASD兒童的尾狀核左、右側以及總體積,在ICV校正前后,均未與ADI-R高水平RRB分或RRB總分表現(xiàn)出顯著相關。此外,自動分割法所得左側以及尾狀核總體積與RBS-R中限制性行為呈顯著性正相關。 (3)兩種計算方法的一致性檢驗：兩種方法的組內(nèi)相關系數(shù)(intraclass correlations, ICC)為尾狀核左側(a=0.746)、右側(α=0.706)、總體積(a=0.797夕,一致性較好。 [結論] 2-3歲的ASD兒童已表現(xiàn)出尾狀核體積的異常增大,且與低水平的RRB相關。本文的發(fā)現(xiàn)強調(diào)了尾狀核在ASD的RRB發(fā)病機制中的作用。此外,在2-3歲兒童腦結構分析中,半自動勾畫法與軟件自動分割法均能夠敏感的探測尾狀核的體積,并且二者結果相近。
[Abstract]:[introduction]
Autism spectrum disorder (autism spectrum, disorder, ASD) is a kind of disease in early childhood neurodevelopmental disorders, repetitive behaviors (restricted, repetitive, behavior, RRB) is one of the core symptoms. It has been found that there was increased and the severity of abnormalities associated with RRB adult patients with ASD caudate nucleus volume, but the relationship between children ASD caudate nucleus volume and RRB to still need further study.
[Objective]
This study selected 2 ~ 3 years old and ASD retardation (developmental delay, DD) of children as the research object, comparative analysis of two groups of subjects were different volume of the caudate nucleus, and to further explore the correlation between the volume with the change of RRB and the severity of the volume of the caudate nucleus. At the same time computing methodology to compare the semi automatic drawing with the software automatic segmentation methods.
[method]
The age of 66 ASD children and 36 gender, three-dimensional magnetic resonance imaging IQ matched DD children using T1-weight weighted sequence head (magnetic resonance imaging, MRI) scanning, respectively using ITK-SNAP software automatic segmentation method for semi automatic drawing method and Freesurfer software, calculated two groups'responses caudate nucleus volume that compares semi automatic drawing software and automatic segmentation method of the ASD group and the DD group of the caudate nucleus volume. At the same time combined with the revised version of the Autism Diagnostic Interview scale (Autism Diagnostic Interview-Revise, ADI-R) in the high and low levels of RRB and RRB and repeat stereotyped behavior scale revised (Repetitivebehaviorscale-revised, RBS-R) respectively subscale scores, correlation analysis of caudate nucleus volume and RRB features and severity.
[results]
(1) the volume comparison of the caudate nucleus in the two groups: the caudate nucleus of group ASD was obtained by using the semi automatic drawing method.
The left (3504.15 + 508.68mm3vs3206.60 + 490.68mm3, P=0.005). The right side of (3683.31 + 483.59mm3vs3313.07 + 453.24mm3, P=0.001) and the total volume (7187.46 + 959.00mm3vs6519.67 + 901.87mm3, P=0.001) than in DD group increased significantly. After adjustment for ICV, the group ASD left caudate nucleus (P0.001), right (P=0.001) and the total volume (P0.001) than the DD group still increased, and the difference was more significant in.Freesurfer software for automatic segmentation calculation in the ASD group of the caudate nucleus on the left (3423.95 + 411.67mm3vs3212.97 + 405.23mm3, P=0.015), right (3543.98 + 396.30mm3vs3337.50 + 414.45mm3, P=0.015) and the total volume (6967.939 + 795.16mm3vs6550.47 + 792.09mm3, P=0.013) than in DD group increased significantly after adjustment; intracranial volume (intracranial volume, ICV), ASD group (P0.001), left caudate nucleus (P0.001) on the right side and the total volume (P0.001) than the DD group still increased, and the difference is more significant.
(2) the correlation analysis of caudate nucleus volume and RRB severity: the results showed that in the ASD group, semi automatic drawing method of the left caudate nucleus (r=0.359, P=0.004), the total volume (r=0.317, P=0.013) were positively correlated with low levels of ADI-R RRB; after adjusting for ICV, semi automatic drawing hook the left caudate nucleus (r=0.417, P=0.001), right (r=0.296, P=0.025) the total volume (r=0.372, P=0.004) and software automatic drawing method the left caudate nucleus (r=0.384, P=0.003), right (r=0.363, P=0.006) and total volume (r=0.385, P =0.003) and ADI-R RRB were significantly low positive correlation; and the two method of the ASD children left the right caudate nucleus, and the total volume, in ICV before and after correction, were not with high levels of ADI-R RRB or RRB scores showed a significant correlation. In addition, the automatic segmentation method and the limiting behavior left caudate nucleus with the total volume of RBS-R was significantly positive Relevant.
(3) consistency check of the two calculation methods: the intraclass correlations (ICC) of the two methods is the left side (a=0.746), the right side (=0.706) and the total volume (a=0.797 a=0.797) of the caudate nucleus.
[Conclusion]
2-3 year old ASD children have shown abnormal increase of volume of the caudate nucleus, and with a low level of RRB. This finding emphasizes the role of the caudate nucleus in the pathogenesis of RRB in ASD. In addition, in the analysis of children aged 2-3 in brain structure, automatic segmentation method for semi automatic drawing method and software are sensitive enough the detection of the volume of the caudate nucleus, and the two results are similar.

【學位授予單位】：南京醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：B848.4

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