比较注意缺陷多动障碍和自闭症谱系障碍患者认知控制过程中大脑结构和功能异常的荟萃分析。
Comparative meta-analyses of brain structural and functional abnormalities during cognitive control in attention-deficit/hyperactivity disorder and autism spectrum disorder.
机构信息
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA.
出版信息
Psychol Med. 2020 Apr;50(6):894-919. doi: 10.1017/S0033291720000574. Epub 2020 Mar 27.
BACKGROUND
People with attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) have abnormalities in frontal, temporal, parietal and striato-thalamic networks. It is unclear to what extent these abnormalities are distinctive or shared. This comparative meta-analysis aimed to identify the most consistent disorder-differentiating and shared structural and functional abnormalities.
METHODS
Systematic literature search was conducted for whole-brain voxel-based morphometry (VBM) and functional magnetic resonance imaging (fMRI) studies of cognitive control comparing people with ASD or ADHD with typically developing controls. Regional gray matter volume (GMV) and fMRI abnormalities during cognitive control were compared in the overall sample and in age-, sex- and IQ-matched subgroups with seed-based d mapping meta-analytic methods.
RESULTS
Eighty-six independent VBM (1533 ADHD and 1295 controls; 1445 ASD and 1477 controls) and 60 fMRI datasets (1001 ADHD and 1004 controls; 335 ASD and 353 controls) were identified. The VBM meta-analyses revealed ADHD-differentiating decreased ventromedial orbitofrontal (z = 2.22, p < 0.0001) but ASD-differentiating increased bilateral temporal and right dorsolateral prefrontal GMV (zs ⩾ 1.64, ps ⩽ 0.002). The fMRI meta-analyses of cognitive control revealed ASD-differentiating medial prefrontal underactivation but overactivation in bilateral ventrolateral prefrontal cortices and precuneus (zs ⩾ 1.04, ps ⩽ 0.003). During motor response inhibition specifically, ADHD relative to ASD showed right inferior fronto-striatal underactivation (zs ⩾ 1.14, ps ⩽ 0.003) but shared right anterior insula underactivation.
CONCLUSIONS
People with ADHD and ASD have mostly distinct structural abnormalities, with enlarged fronto-temporal GMV in ASD and reduced orbitofrontal GMV in ADHD; and mostly distinct functional abnormalities, which were more pronounced in ASD.
背景
患有注意力缺陷/多动障碍（ADHD）和自闭症谱系障碍（ASD）的人在前额、颞叶、顶叶和纹状体-丘脑网络中存在异常。这些异常在多大程度上是独特的或共同的尚不清楚。这项比较性荟萃分析旨在确定最一致的疾病区分和共同的结构和功能异常。
方法
系统地搜索了比较 ASD 或 ADHD 患者与正常发育对照者认知控制的全脑体素形态学（VBM）和功能磁共振成像（fMRI）研究的文献。使用基于种子的 d 映射元分析方法，在总体样本以及年龄、性别和智商匹配的亚组中比较认知控制期间的区域灰质体积（GMV）和 fMRI 异常。
结果
确定了 86 项独立的 VBM（1533 例 ADHD 和 1295 例对照；1445 例 ASD 和 1477 例对照）和 60 项 fMRI 数据集（1001 例 ADHD 和 1004 例对照；335 例 ASD 和 353 例对照）。VBM 荟萃分析显示，ADHD 存在区分性的腹内侧眶额皮质 GMV 减少（z=2.22，p<0.0001），而 ASD 存在区分性的双侧颞叶和右侧背外侧前额叶 GMV 增加（zs ⩾1.64，ps ⩽0.002）。认知控制的 fMRI 荟萃分析显示，ASD 存在内侧前额叶激活不足，但双侧腹外侧前额叶皮质和楔前叶过度激活（zs ⩾1.04，ps ⩽0.003）。具体而言，在运动反应抑制中，ADHD 相对于 ASD 显示右侧下额-纹状体激活不足（zs ⩾1.14，ps ⩽0.003），但共同存在右侧前岛叶激活不足。
结论
ADHD 和 ASD 患者的结构异常主要是独特的，ASD 存在额颞 GMV 增大，ADHD 存在眶额 GMV 减少；功能异常主要是独特的，在 ASD 中更为明显。
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