Evidence of brain overgrowth in the first year of life in autism
Evidence of brain overgrowth in the first year of life in autism
复制标题
DOI：
10.1001/jama.290.3.337
复制
发表时间：
2003-07-16
影响因子：
120.7
通讯作者：
Akshoomoff, N
中科院分区：
文献类型：
--
作者：
Courchesne, E;Carper, R;Akshoomoff, N
自闭症最常出现在2到3岁的时候，那时大脑已经异常大。这提出了大脑过度生长开始得更早的可能性，也许在第一个临床上明显的行为症状之前。目的为了确定病理性大脑过度生长是否先于自闭症谱系障碍（ASD）的第一个临床症状，以及第一年期间的过度生长率是否与儿童早期的神经解剖学和临床结果有关。第一年的体重测量结果来自48名2至5岁的ASD儿童的医疗记录，他们参加了磁共振成像研究。在这些儿童中，（纵向组）在婴儿期的4个时期进行测量：出生、1 ~ 2个月、3 ~ 14个月和6 ~ 14个月;和33（部分HC数据组）在出生时和6至14个月时（n=7）和仅在出生时（n=28）进行测量。使用2个国家认可的规范性数据库：来自全国调查的横断面规范性数据和个体生长的纵向数据，评价这些变化与脑解剖结构和2 - 5年临床和诊断结果的关系。结果ASD患儿的出生HC值明显低于正常对照组（z=-0.66，P2.0SDs）; 59%的自闭症婴儿表现出这些加速的生长轨迹。结论自闭症的临床发病似乎是由两个阶段的大脑发育异常：出生时头部尺寸减小，以及在1至2个月和6至14个月之间头部尺寸突然过度增加。异常加速的生长速度可能是自闭症风险的早期预警信号。
Context Autism most commonly appears by 2 to 3 years of life, at which time the brain is already abnormally large. This raises the possibility that brain overgrowth begins much earlier, perhaps before the first clinically noticeable behavioral symptoms.Objectives To determine whether pathological brain overgrowth precedes the first clinical signs of autism spectrum disorder (ASD) and whether the rate of overgrowth during the first year is related to neuroanatomical and clinical outcome in early childhood.Design, Setting, and Participants Head circumference (HQ, body length, and body weight measurements during the first year were obtained from the medical records of 48 children with ASD aged 2 to 5 years who had participated in magnetic resonance imaging studies. Of these children, 15 (longitudinal group) had measurement at 4 periods during infancy: birth, 1 to 2 months, 3 to months, and 6 to 14 months; and 33 (partial HC data group) had measurements at birth and 6 to 14 months (n=7), and at birth only (n=28).Main Outcome Measures Age-related changes in infants with ASD who had multiple-age measurements, and the relationship of these changes to brain anatomy and clinical and diagnostic outcome at 2 to 5 years were evaluated by using 2 nationally recognized normative databases: cross-sectional normative data from a national survey and longitudinal data of individual growth. Results Compared with normative data of healthy infants, birth HC in infants with ASD was significantly smaller (z= -0.66, P2.0 SDs) from birth to 6 to 14 months; 59% of infants with autistic disorder showed these accelerated growth trajectories.Conclusions The clinical onset of autism appears to be preceded by 2 phases of brain growth abnormality: a reduced head size at birth and a sudden and excessive increase in head size between 1 to 2 months and 6 to 14 months. Abnormally accelerated rate of growth may serve as an early warning signal of risk for autism.