Assessment of the glymphatic function in children with attention-deficit/hyperactivity disorder
Assessment of the glymphatic function in children with attention-deficit/hyperactivity disorder
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注意缺陷/多动障碍患儿类淋巴系统功能的评估
DOI：
10.1007/s00330-023-10220-2
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发表时间：
2023-09
影响因子：
5.9
通讯作者：
Yingqian Chen;Miaomiao Wang;Shu Su;Yan Dai;Mengsha Zou;Liping Lin;Long Qian;Xianjun Li;Hongyu Zhang;Meina Liu;Jianping Chu;Jian Yang;Zhiyun Yang
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作者：
Yingqian Chen;Miaomiao Wang;Shu Su;Yan Dai;Mengsha Zou;Liping Lin;Long Qian;Xianjun Li;Hongyu Zhang;Meina Liu;Jianping Chu;Jian Yang;Zhiyun Yang
目的神经发育性疾病中是否存在淋巴系统的改变尚不清楚。在这项研究中，我们通过定量测量Virchow-Robin间隙(VRS)的体积和沿血管周围间隙的扩散张量图像分析(DTI-Alps)来研究治疗初期注意缺陷多动障碍(ADHD)儿童淋巴系统的结构和功能的变化。在轴位T2加权图像上使用半自动方法计算VRS体积。测量了投射、联合和皮质下神经纤维区沿x轴、y轴和z轴的扩散系数。计算阿尔卑斯指数(Alps Index)，这是一个加剧血管周围空间水分扩散的比率。结果注意缺陷多动障碍组的脑动静脉窦体积(平均15.514 mLvs.11.702 mLVRS)和脑动静脉窦体积比均大于TD组(均为 0.001)。ADHD组联合纤维区沿x轴方向的弥散率和阿尔卑斯指数显著低于TD组(平均1.40vs.1.59，P<； 校正后P<；0.05)。阿尔卑斯指数与注意缺陷多动障碍的注意症状呈正相关(r= − 0.323，p<； 0.0 5)。结论本研究提示注意力缺陷多动障碍的发生可能与淋巴系统的改变有关，这可能是探讨心理行为发育障碍发病机制的新方向。此外，VRS体积和Alps指数可以作为诊断ADHD的指标。临床相关性陈述考虑到淋巴系统在探索注意缺陷/多动机制方面的潜在相关性，Virchow-Robin间隙体积和沿血管周围间隙指数的分析可以作为诊断该疾病的额外指标。关键点·在治疗天真的注意缺陷/多动障碍儿童中，发现Virchow-Robin间隙体积增加和沿血管周围间隙指数分析减少。·本研究结果表明，淋巴系统的改变在注意缺陷/多动障碍的发病机制中可能起到有价值的作用。·沿血管周围间隙指数的分析与注意缺陷/多动障碍儿童的注意缺陷症状相关。
ObjectivesWhether the alternation of the glymphatic system exists in neurodevelopmental disease still remains unclear. In this study, we investigated structural and functional changes in the glymphatic system in the treatment-naïve attention-deficit/hyperactivity disorder (ADHD) children by quantitatively measuring the Virchow-Robin spaces (VRS) volume and diffusion tensor image-analysis along the perivascular space (DTI-ALPS).MethodsForty-seven pediatric ADHD patients and 52 age- and gender-matched typically developing (TD) children were recruited in this prospective study. The VRS volume was calculated using a semi-automated approach in axial T2-weighted images. Diffusivities along thex-,y-, andz-axes in the projection, association, and subcortical neural fiber areas were measured. The ALPS index, a ratio that accentuated water diffusion along the perivascular space, was calculated. The Mann-WhitneyUtest was used to compare the quantitative parameters; Pearson’s correlation was used to analyze the correlation with clinical symptoms.ResultsThe cerebral VRS volume (mean, 15.514 mL vs. 11.702 mL) and the VRS volume ratio in the ADHD group were larger than those in the TD group (allp< 0.001). The diffusivity along thex-axis in association fiber area and ALPS index were significantly smaller in the ADHD group vs. TD group (mean, 1.40 vs.1.59,p< 0.05 after false discovery rate adjustment). Besides, the ALPS index was related to inattention symptoms of ADHD (r= − 0.323,p< 0.05).ConclusionsOur study suggests that the glymphatic system alternation may participate in the pathogenesis of ADHD, which may be a new research direction for exploring the mechanisms of psycho-behavioral developmental disorders. Moreover, the VRS volume and ALPS index could be used as the metrics for diagnosing ADHD.Clinical relevance statementConsidering the potential relevance of the glymphatic system for exploring the mechanisms of attention deficit/hyperactivity, the Virchow-Robin spaces volume and the analysis along the perivascular space index could be used as additional metrics for diagnosing the disorder.Key Points• Increased Virchow-Robin space volume and decreased analysis along the perivascular space index were found in the treatment-naïve attention-deficit/hyperactivity disorder children.• The results of this study indicate that the glymphatic system alternation may have a valuable role in the pathogenesis of attention-deficit/hyperactivity disorder.• The analysis along the perivascular space index is correlated with inattention symptoms of attention-deficit/hyperactivity disorder children.