首发抽动障碍儿童基底节结构异常的磁共振成像研究

目的:探讨抽动障碍(TD)儿童基底节结构异常特点及其与病程、疾病严重程度之间的相关性。方法:对9例符合美国精神障碍诊断与统计手册第4版(DSM-Ⅳ)中TD标准的首发未用药6～14岁TD儿童,采用耶鲁综合抽动严重程度量表(YGTSS)对TD儿童进行临床评估,同时收集9例8～10岁健康儿童,对受试者进行脑结构磁共振扫描,采用感兴趣区法对基底节及其亚区尾状核、壳核、苍白球分别进行测量,比较两组上述脑区的原始体积、相对体积(原始体积/颅内总体积)、左右不对称性指数(AI)的差异,分析基底节及其各亚区体积与患者病程、YGTSS总分之间相关性。结果:患儿组右侧苍白球原始体积(1.4±0.2)mL vs.(1.1±0.1)mL]及其相对体积(0.9±0.1)×10-3vs.(0.7±0.2)×10-3]均高于对照组(均P0.01);其他各结构原始体积及其相对体积组间差异均无统计学意义(均P0.05)。患儿组尾状核体积(4.9±0.4)mL vs.(4.7±0.5)mL]和对照组尾状核体积两组组内左右侧比较(4.7±0.5)mL vs.(4.5±0.5)mL],结果显示左侧均高于右侧(均P0.05);其他各结构组内左右侧体积的比较,差异均无统计学意义(均P0.05)。两组间基底节及其各亚区AI值差异无统计学意义(P0.05);患儿组各结构相对体积与YGTSS总分(r=-0.08～0.63)和病程(r=-0.09～0.59)均无明显相关(均P0.05)。结论:抽动障碍儿童脑右侧苍白球体积明显大于健康儿童,可能为该症的异常脑结构之一;抽动障碍儿童基底节及各亚区结构体积大小与病程、疾病严重程度无明显相关。

Basal ganglia structure abnormalities of the children with the first-episode tic disorder:A magnetic resonance imaging study

Objective: To explore the brain structural characteristics of the basal ganglia of children with tic disorder(TD) and the correlations between the structural abnormailities and the duration or severity of TD.Methods: Using brain structural magnetic resonance imaging technique(MRI),we recruited 9 unmedicated,6-14 years old,the first episode patients with TD according to the Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition(DSM-Ⅳ) diagnostic criteria,and 9 healthy children,age of 8-10 years to conduct the MRI scans.The scale of Yale Global Tic Severity Scale(YGTSS) was used to assess the tic severity.The volumes of total basal ganglia and its subregions including caudate nucleus,putamen,globus pallidus were measured using the method of region of interest.The original volumes,relative volumes(the ratio between the original volume and total intracranial volume) and asymmetry index(AI) of the basal ganglia and its subregions between the two groups were compared.Finally,the correlations were analyzed between the relative volume changes of the basal ganglia and its subregions and the illness duration or the total scores of YGTSS.Results: The original volume of the right globus pallidus (1.4±0.2) mL vs.(1.1±0.1) mL]and relative volume (0.9±0.1)×10-3 vs.(0.7±0.2) ×10-3] in patients with TD were respectively significantly larger than those of controls(Ps<0.05),whilst there was no significant difference on the volumes of the other regions between two groups(Ps>0.05).The orginal volume of the left caudate nucleus was larger than that of right caudate nucleus in the group of TD patients (4.9±0.4) mL vs.(4.7±0.5) mL] or controls (4.7±0.5) mL vs.(4.5±0.5) mL],while there was no significant difference between left and right volume within other subregions(Ps<0.05).There was no significant difference in the asymmetry index in the basal ganglia and its subregions between two groups(Ps>0.05).The relative volumes in the basal ganglia or its subregions did not significantly correlate with the severity of tic(r=-0.08-0.63,Ps>0.05) and the duration of the disease(r=-0.09-0.59,Ps>0.05).Conclusion:The right globus pallidus in TD patients is possibly larger than controls,which may be the abnormal brain structure of TD.The relative volume of any structure of basal ganglia has no significant correlation with the severity or course of disease.