孤獨(dú)癥顱腦MRI研究進(jìn)展2017

孤獨(dú)癥顱腦MRI研究進(jìn)展,胡冰 副主任醫(yī)師中山大學(xué)附屬第三醫(yī)院放射科,廣東省醫(yī)學(xué)會(huì)第十六次放射醫(yī)學(xué)學(xué)術(shù)會(huì)議,國家自然科學(xué)基金青年項(xiàng)目，項(xiàng)目編號(hào)：31100738李詠梅、胡冰、李建英、孟安啟、易莉、梁亞勇、陳碧媛、李冬蘊(yùn),Brain MRI research progress in autism,Bing Hu MDAssociate Chief Physician, Department of Radiology, the Third Affiliated Hospital of SUN Yat-sen University,前言,獲得1989年奧斯卡最佳影片最佳導(dǎo)演最佳原創(chuàng)劇本最佳男主角,雨人巴里萊文森1988年執(zhí)導(dǎo)的一部劇情電影。,目錄,孤獨(dú)癥簡(jiǎn)介相關(guān)學(xué)科研究MRI研究進(jìn)展早期MRI研究00sMRI研究10sMRI研究今年MRI研究參考文獻(xiàn),目錄,孤獨(dú)癥簡(jiǎn)介相關(guān)學(xué)科研究MRI研究進(jìn)展早期MRI研究00sMRI研究10sMRI研究今年MRI研究參考文獻(xiàn),1. 孤獨(dú)癥簡(jiǎn)介,孤獨(dú)癥是一種神經(jīng)系統(tǒng)失調(diào)導(dǎo)致的發(fā)育障礙早期不能進(jìn)行正常的語言表達(dá)和社交活動(dòng)常做出一些刻板、重復(fù)性和限制性的動(dòng)作Autism 一詞源于希臘語autor，原意為自我孤獨(dú)癥患者的突出特征 - 自我興趣孤獨(dú)癥和自閉癥是 Autism 的兩種譯名男性多于女性,孤獨(dú)癥的首次發(fā)現(xiàn),1943年，在約翰霍普金斯醫(yī)院工作的醫(yī)生Leo Kanner發(fā)表了第一篇關(guān)于孤獨(dú)癥的論文5 歲男孩Donald是第一個(gè)被診斷為孤獨(dú)癥的孩子“每當(dāng)自己一個(gè)人的時(shí)候，總會(huì)感覺自己很幸福，且不愿意其他人打攪他獨(dú)處”Leo Kanner,1Kanner L. Autistic disturbances of affective contact. Acta Paedopsychiatr, 1968, 35(4): 100-136.,診斷標(biāo)準(zhǔn)的演變,1973年WHO1980年DSM-III1987年DSM-III-R1989年ICD-101994年DSM-IV2000年DSM-IV-TR2013年DSM-VThe Diagnostic and Statistical Manual of Mental Disorders精神疾病診斷與統(tǒng)計(jì)手冊(cè)International Classification of Diseases國際疾病分類,DSM-V（2013）,統(tǒng)稱為孤獨(dú)癥譜系障礙（autistic spectrum disorders, ASD）診斷標(biāo)準(zhǔn)：A. 在各種情景下持續(xù)存在的社會(huì)交流和社會(huì)交往缺陷，包括在現(xiàn)在或過去有以下表現(xiàn):（1）社會(huì)-情感互動(dòng)缺陷（2）用于社會(huì)交往的非言語交流行為缺陷（3）建立或維持與其發(fā)育水平相符的人際關(guān)系缺陷,DSM-V,B. 狹隘、重復(fù)的行為方式、興趣或活動(dòng)內(nèi)容，包括在現(xiàn)在或過去有以下表現(xiàn)的至少兩項(xiàng):（1）語言、運(yùn)動(dòng)或物體運(yùn)用刻板或重復(fù) （2）過分堅(jiān)持某些常規(guī)以及言語或非言語行為的儀式，或?qū)Ω淖兊倪^分抵抗 （3）高度狹隘、固定的興趣，其在強(qiáng)度和關(guān)注度上是異常的（4）對(duì)感覺刺激反應(yīng)過度或反應(yīng)低下，對(duì)環(huán)境中的感覺刺激表現(xiàn)出異常的興趣,DSM-V,C. 癥狀必須在兒童早期出現(xiàn)D. 所有癥狀共同限制和損害了日常功能E. 這些癥狀不能用智力發(fā)育障礙或全面發(fā)育遲緩解釋,1Coplan J. Atypicality, intelligence, and age: a conceptual model of autistic spectrum disorder. Dev Med Child Neurol, 2003, 45(10): 712-716.2Coplan J, Jawad AF. Modeling clinical outcome of children with autistic spectrum disorders. Pediatrics, 2005, 116(1): 117-122.,1Coplan J. Atypicality, intelligence, and age: a conceptual model of autistic spectrum disorder. Dev Med Child Neurol, 2003, 45(10): 712-716.2Coplan J, Jawad AF. Modeling clinical outcome of children with autistic spectrum disorders. Pediatrics, 2005, 116(1): 117-122.,孤獨(dú)癥的診斷,沒有特異性實(shí)驗(yàn)室診斷手段CT、MRI、SPECT、PET、腦電圖、染色體、誘發(fā)電位等檢查有助鑒別診斷根據(jù)典型臨床表現(xiàn)自閉癥診斷不難診斷可根據(jù)DSM-V為標(biāo)準(zhǔn)CHAT、CARS、ABC是國內(nèi)常用篩查量表ADI-R、ADOS是診斷“金標(biāo)準(zhǔn)”，新的篩查量表如SRS考慮了譜系障礙的問題,目錄,孤獨(dú)癥簡(jiǎn)介相關(guān)學(xué)科研究MRI研究進(jìn)展早期MRI研究00sMRI研究10sMRI研究今年MRI研究參考文獻(xiàn),1Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. 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