不同亚型注意缺陷多动障碍患者的脑白质微观结构差异及分类研究  

White matter microstructural alterations and classification of patients with different subtypes of attention-deficit/hyperactivity disorder

作　　者：陈丽舟[1] 李倩[1] 罗乐凯 陈颖[1] 李元媛[2] 何宁[2] 李飞[1] CHEN Lizhou;LI Qian;LUO Lekai;CHEN Ying;LI Yuanyuan;HE Ning;LI Fei(Huaxi MR Research Center,Department of Radiology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China;Mental Health Center,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院放射科华西磁共振研究中心,成都610041 [2]四川大学华西医院心理卫生中心,成都610041

出　　处：《华西医学》2023年第3期408-415,共8页West China Medical Journal

基　　金：国家自然科学基金(81801683,81801358);四川省卫生健康委员会科研课题(19PJ247)。

摘　　要：目的探索不同亚型注意缺陷多动障碍(attention-deficit/hyperactivity disorder,ADHD)患者脑白质微观结构异常并建立分类模型。方法前瞻性纳入2019年1月-2021年9月就诊于四川大学华西医院的ADHD患者及经广告招募的健康对照者,所有受试者均接受弥散张量成像扫描。通过全脑基于体素的分析对混合型ADHD(combined subtype of ADHD,ADHD-C)、注意缺陷型ADHD(inattentive subtype of ADHD,ADHD-I)和对照组的各向异性分数(fractional anisotropy,FA)参数图进行组间比较。运用支持向量机分类器及特征选择方法构建个体化ADHD分类模型,并对3组受试者两两之间的分类效能进行检测。结果共纳入26例ADHD-C型、24例ADHD-I型患者及26例健康对照者。3组受试者在双侧颞叶白质矢状层及胼胝体峡部FA值差异有统计学意义(P<0.005),前者表现为ADHD-C型患者<ADHD-I型患者<对照者,后者表现为ADHD-C型患者>ADHD-I型患者>对照者;两组亚型之间的差异点位于右侧额中回白质,表现为ADHD-C型>ADHD-I型。基于FA图的分类模型在对两种亚型患者间的分类预测中效能最高(P<0.05,总体准确率=76.0%,灵敏度=88.5%,特异度=70.8%)。结论两种亚型患者额脑白质微观结构异常既存在共性也存在异质性。颞叶矢状层和胼胝体的白质损害可能是ADHD疾病本身的病理生理基础,而额叶区域的异常改变或为不同亚型患者间的区分点。Objective To explore the white matter microstructural abnormalities in patients with different subtypes of attention-deficit/hyperactivity disorder(ADHD)and establish a diagnostic classification model.Methods Patients with ADHD admitted to West China Hospital of Sichuan University between January 2019 and September 2021 and healthy controls recruited through advertisement were prospectively selected.All participants underwent diffusion tensor imaging scanning.The whole brain voxel-based analysis was used to compare the diffusion parameter maps of fractional anisotropy(FA)among patients with combined subtype of ADHD(ADHD-C),patients with inattentive subtype of ADHD(ADHD-I)and healthy controls.The support vector machine classifier and feature selection method were used to construct the individual ADHD diagnostic classification model and efficiency was evaluated between each two groups of the ADHD patients and healthy controls.ResultsA total of 26 ADHD-C patients,24 ADHD-I patients and 26 healthy controls were included.The three groups showed significant differences in FA values in the bilateral sagittal stratum of temporal lobe(ADHD-C<ADHD-I<healthy controls)and the isthmus of corpus callosum(ADHD-C>ADHD-I>healthy controls)(P<0.005).The direct comparison between the two subtypes of ADHD showed that ADHD-C had higher FA than ADHD-I in the right middle frontal gyrus.The classification model differentiating ADHD-C and ADHD-I showed the highest efficiency,with a total accuracy of 76.0%,sensitivity of 88.5%,and specificity of 70.8%.Conclusions There is both commonality and heterogeneity in white matter microstructural alterations in the two subtypes of patients with ADHD.The white matter damage of the sagittal stratum of temporal lobe and the corpus callosum may be the intrinsic pathophysiological basis of ADHD,while the anomalies of frontal brain region may be the differential point between different subtypes of patients.

关 键 词：注意缺陷多动障碍 亚型 脑白质 支持向量机 

分 类 号：R749.94[医药卫生—神经病学与精神病学]