本文選題：孤獨癥譜系障礙 + 腦白質(zhì)��； 參考：《南京醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[引言]孤獨癥譜系障礙(Autism Spectrum Disorder,ASD)是一種起病于兒童早期的神經(jīng)發(fā)育障礙,其核心臨床表現(xiàn)是社會交流障礙和局限、刻板的興趣及行為。已有研究顯示ASD患兒在兒童期、青少年期及成人期腦白質(zhì)纖維束的完整性存在異常,但多數(shù)研究為橫斷面研究,縱向觀察研究很少,尤其缺乏從ASD起病初期即開始的隨訪性研究。[目的]本研究選取71例2～3歲ASD及年齡、智能相匹配的發(fā)育遲緩(Developmental Delay,DD)兒童為研究對象,對比分析入組時兩組被試腦白質(zhì)主要纖維束的完整性上的差別及其與臨床癥狀之間的相關(guān)性;再通過兩年的隨訪,對比觀察ASD組及DD組兒童兩年間白質(zhì)纖維束完整性的變化,以期發(fā)現(xiàn)ASD患兒腦白質(zhì)主要纖維束發(fā)育軌跡的異常。[方法]運用兒童孤獨癥評定量表(Childhood Autism Rating Scale,CARS)、孤獨癥診斷訪談修訂版(Autism Diagnoses Interview-Revised,ADI-R)、孤獨癥療效評估(Autism Treatment Evaluation Checklist,ATEC)等評估工具對 40 名 ASD組及31名DD組兒童進行第一次臨床心理評估,同時進行T1加權(quán)三維磁共振成像(Magnetic Resonance Imaging,MRI)和彌散張量成像(Diffusion Tensor Imaging,DTI)掃描,隨訪兩年后重新評估并完成第二次核磁共振掃描。應(yīng)用基于感興趣區(qū)(Region of Interest,ROI)的方法對兩組被試的腦影像學(xué)數(shù)據(jù)進行分析,橫向比較兩組被試在兩個年齡段時腦白質(zhì)重要纖維束結(jié)構(gòu)完整性的差異,主要觀察指標為19條纖維束(21個ROI)的平均各向異性分數(shù)(Fraction Anisotropy,FA),然后進一步分析ASD組各條纖維束FA值的變化與臨床特征(CARS量表總分、ADI-R和ATEC量表的各個分量表分)之間的相關(guān)性。[結(jié)果]1.在2～3歲時,與DD組相比ASD組21個感興趣區(qū)的白質(zhì)纖維束的平均FA值差異均無顯著性(p均0.05);ASD組21個感興趣區(qū)的纖維束的FA值與臨床癥狀的相關(guān)分析顯示:ATEC量表的總分與右側(cè)內(nèi)囊前支的FA值負相關(guān)(r=-0.343,p=0.041);ATEC 量表的語言分量表分與總胼胝體(r=-0.347,p=0.038)、胼胝體膝部(r=-0.358,p=0.032)、右側(cè)內(nèi)囊前支(r=-0.351,p=0.036)、左側(cè)內(nèi)囊(r=-0.367,p=0.028)、左側(cè)扣帶回(r=-0.338,p=0.043)、左側(cè)鉤束、(r=-0.337,p=0.044)以及左側(cè)額枕下束(r=-0.368,p=0.027)的平均FA值呈負相關(guān);ATEC量表的社交分量表分與右側(cè)內(nèi)囊(r=-0.355,p=0.033)和右側(cè)內(nèi)囊后支(r=-0.362,p0.030)負相關(guān);CARS量表總分及ADI-R量表的各分量表分與ASD組21個感興趣區(qū)纖維束的FA值之間無相關(guān)性(p均0.05)。2.在4～5歲時,與DD組相比ASD組兒童總胼胝體、胼胝體膝部、雙側(cè)鉤束、左側(cè)扣帶束、雙側(cè)內(nèi)囊、右側(cè)內(nèi)囊后支、左側(cè)內(nèi)囊前支及右側(cè)下縱束的FA值降低,差異具有顯著性(p均0.05)。ASD組21個感興趣區(qū)纖維束的FA值與臨床癥狀的相關(guān)分析顯示:ATEC量表總分與右側(cè)弓狀束的FA值正相關(guān)(r=0.370,p=0.029);ATEC量表社交分量表分與左側(cè)弓狀束的FA值正相(r=0.362,p=0.033);ATEC量表感知覺分量表分與左側(cè)額枕下束的FA值負相關(guān)(r-0.376,p=0.026);ADI-R量表起病的項目分與左側(cè)弓狀束的FA值正相關(guān)(r=0.482,p=0.030);ASD組CARS量表總分及其他ADI-R量表的各分量表分與21個感興趣區(qū)纖維束的FA值與之間的無相關(guān)性(p均0.05)。3.對比分析ASD組兩年間21個感興趣區(qū)纖維束的FA值的變化結(jié)果發(fā)現(xiàn),除胼胝體壓部外其余的纖維束的FA值兩年后均增大,差異有顯著性(p均0.05)。[結(jié)論]在2～5歲期間ASD患兒腦白質(zhì)重要纖維束完整性的受損程度隨著年齡的增加而增加,且與核心臨床癥狀相關(guān)。
[Abstract]:[introduction] Autism Spectrum Disorder (ASD) is a kind of early childhood neurodevelopmental disorder. Its core clinical manifestations are social communication disorders and limitations, stereotyped interest and behavior. The study shows that the integrity of the white matter fiber bundles in children with ASD in childhood, adolescence and adult stage is abnormal, but there is an abnormality in the integrity of the white matter fiber bundles in childhood, adolescence and adult. Most studies are transect studies, and there are few longitudinal observation studies, especially a follow-up study that begins at the beginning of the onset of ASD. [Objective] this study selected 71 children aged 2~3 years and age ASD and age, Developmental Delay, DD children as the research object, and compared and analyzed the main fibrous bundle of white matter in the two groups. The difference in integrity and its correlation with clinical symptoms; and after two years' follow-up, the changes in the integrity of white matter fiber bundles in ASD and DD children were observed for two years, in order to find out the abnormal development of the main bundle of white matter in children with ASD. [Methods] the children autism Assessment Scale (Childhood Autism Rating Scale) was used. CARS), Autism Diagnoses Interview-Revised (ADI-R), the evaluation of autism efficacy assessment (Autism Treatment Evaluation Checklist, ATEC), the first clinical psychological assessment of 40 ASD and 31 children of DD groups. MRI) and diffusion tensor imaging (Diffusion Tensor Imaging, DTI) scan, reassessing and completing second NMR scans two years later. Using a method based on the region of interest (Region of Interest, ROI), the brain imaging data of the two groups were analyzed, and the two groups were compared with the two age groups of the brain white matter fiber. The difference in the integrity of the bundle structure was the main observation index of the average anisotropic fraction (Fraction Anisotropy, FA) of 19 fiber bundles (21 ROI), and then further analyzed the correlation between the changes in the FA value of the fiber bundles in the ASD group and the clinical features (the CARS scale, the ADI-R and the various components of the ATEC scale). [results]1. was at the age of 2~3, Compared with group DD, the average FA value of white matter fiber bundles in 21 regions of interest of ASD group was not significant (P 0.05). The correlation analysis between the FA value of fiber bundles in 21 regions of interest of ASD and clinical symptoms showed that the total score of the ATEC scale was negatively correlated with the FA value of the anterior branch of the right internal capsule (r= -0.343, p=0.041), and the language subscales of the ATEC scale and the total corpus callus. R=-0.347 (p=0.038), the genu of the corpus callosum (r=-0.358, p=0.032), the right anterior internal capsule (r=-0.351, p=0.036), the left internal capsule (r=-0.367, p=0.028), the left cingulate gyrus (r=-0.338, p=0.043), the left hook bundle, (r=-0.337, p=0.044), and the left inferior occipital bundle were negatively correlated; the social component and right of the scale The negative correlation between the lateral internal capsule (r=-0.355, p=0.033) and the right posterior branch of the internal capsule (r=-0.362, p0.030) was negative. There was no correlation between the total score of the CARS scale and the ADI-R scale and the FA of the 21 regions of the ASD group (P 0.05) (P 0.05).2. at the age of 4~5, compared with the DD group, the total corpus callosum of the ASD group, the corpus callosum, the bilateral hook bundle, the left cingulate bundle, The FA value of the lateral internal capsule, the right posterior branch of the internal capsule, the left anterior branch of the left inner capsule and the right inferior longitudinal fascicle was significant (P 0.05). The correlation analysis between the FA value of the fiber bundles in the 21 regions of interest of the.ASD group and the clinical symptoms showed that the total score of the ATEC scale was positively correlated with the FA value of the right arcuate bundle (r=0.370, p=0.029), and the social component of the ATEC scale and the left bow. The FA value of the bundle was positive (r=0.362, p=0.033); the sensory perception component of the ATEC scale was negatively correlated with the FA value of the left occipital tract (r-0.376, p=0.026); the item of the onset of the ADI-R scale was positively correlated with the FA value of the left arcuate bundle (r=0.482, p=0.030), and the components of the ASD group and the other 21 regions of interest zone fiber bundles. FA value and no correlation (P 0.05).3. comparison and analysis of the FA value of 21 region of interest zone fiber bundles in the ASD group two years later, the results showed that the FA value of the rest of the fiber bundles except the corpus callosum was increased two years later, the difference was significant (P all 0.05). [Conclusion] the damage process of the integrity of the important fibrous bundle of white matter in the 2~5 year old ASD children It increased with age and correlated with core clinical symptoms.
【學(xué)位授予單位】：南京醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R749.94

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