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目的:探讨注意缺陷多动障碍(ADHD)及共患学习困难(LD)儿童大脑灰质、白质和全脑体积的特点。方法:本研究共纳入符合美国精神障碍诊断与统计手册第4版(DSM-IV)之相应诊断标准的36例ADHD儿童,以及性别、年龄均匹配的36名正常对照。ADHD儿童中有18例共患LD(ADHD+LD组)、18例不共患LD(ADHD-LD组)。以中国儿童-韦氏智力测定量表(C-WISC)、利手问卷评定被试的智商和利手状况。以磁共振成像检查收集被试的大脑影像。采用基于体素的形态学测量(voxelbased morphometry,VBM)方法研究ADHD组与对照组脑结构的差异,同时分析共病LD患者大脑体积的特点。结果:与正常对照相比,ADHD儿童大脑灰质[(746.9±68.3)mm3vs.(790.5±72.2)mm3]和全脑[(1212.4±115.2)mm3vs.(1270.6±113.1)mm3]体积减小(P<0.05),白质体积组间差异无统计学意义。与对照组相比,ADHD+LD组灰质[(731.1±69.5)mm3vs.(790.5±72.2)mm3]、白质[(435.2±51.1)mm3vs.(480.1±50.5)mm3]和全脑[(1166.3±112.3)mm3vs.(1270.6±113.1)mm3]体积减小(P<0.05);与ADHD-LD相比,ADHD+LD组白质[(435.2±51.1)mm3vs.(495.7±55.7)mm3]和全脑[(1166.3±112.3)mm3vs.(1258.3±100.9)mm3]体积减小(P<0.05);ADHD-LD和对照组大脑体积组间差异无统计学意义。结论:ADHD儿童存在灰质体积和全脑体积减小,共患LD会使ADHD儿童大脑体积更小,提示大脑体积异常可能参与LD和/或ADHD的发病机制以及ADHD共病LD的病理机制。
Objective: To investigate the characteristics of cerebrum gray matter, white matter and whole brain volume in children with attention deficit hyperactivity disorder (ADHD) and comorbid learning difficulties (LD). METHODS: Thirty-six children with ADHD who met the corresponding diagnostic criteria of DSM-IV (Fourth Edition, Diagnostic and Statistical Manual of Mental Disorders) and 36 healthy controls matched for gender and age were enrolled in this study. In ADHD children, there were 18 patients with LD (ADHD + LD) and 18 patients with LD (ADHD-LD). The Chinese children’s Wechsler Intelligence Scale (C-WISC) and the Hand-Held Questionnaire were used to assess the intelligence and proficiency of the participants. The brain images of subjects were collected by magnetic resonance imaging. The voxelbased morphometry (VBM) method was used to study the difference of brain structure between ADHD group and control group, meanwhile, the brain volume of patients with comorbid LD was analyzed. Results: Compared with the normal controls, the gray matter in the brain of children with ADHD [(746.9 ± 68.3) mm3 vs (790.5 ± 72.2) mm3] and whole brain [(1212.4 ± 115.2) mm3 vs <0.05), there was no significant difference in white matter volume between groups. Compared with the control group, gray matter [(731.1 ± 69.5) mm3vs. (790.5 ± 72.2) mm3], white matter [(435.2 ± 51.1) mm3vs. (480.1 ± 50.5) mm3] and whole brain [(1166.3 ± (435.2 ± 51.1) mm3 vs (495.7 ± 55.7) mm3] and whole brain in ADHD + LD group compared with ADHD-LD group (112.3 ± mm3 vs 1270.6 ± 113.1 mm3) [(1166.3 ± 112.3) mm3 vs (1258.3 ± 100.9) mm3] (P <0.05). There was no significant difference in brain volume between ADHD-LD and control groups. CONCLUSIONS: There is a decrease in gray matter volume and whole brain volume in children with ADHD. Co-suffering LD may make the brain smaller in children with ADHD, indicating that abnormal brain volume may be involved in the pathogenesis of LD and / or ADHD and the pathological mechanism of ADHD comorbid LD.