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一项关于极早产青少年精神症状与障碍和脑灰质体积之间关联的纵向研究。

A longitudinal study of associations between psychiatric symptoms and disorders and cerebral gray matter volumes in adolescents born very preterm.

作者信息

Botellero Violeta L, Skranes Jon, Bjuland Knut Jørgen, Håberg Asta Kristine, Lydersen Stian, Brubakk Ann-Mari, Indredavik Marit S, Martinussen Marit

机构信息

Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, Medical Technology Research Center, P.O. Box 8905, NO-7491, Trondheim, Norway.

Department of Pediatrics, Sørlandet Hospital, Arendal, Norway.

出版信息

BMC Pediatr. 2017 Feb 1;17(1):45. doi: 10.1186/s12887-017-0793-0.

Abstract

BACKGROUND

Being born preterm with very low birthweight (VLBW ≤ 1500 g) poses a risk for cortical and subcortical gray matter (GM) abnormalities, as well as for having more psychiatric problems during childhood and adolescence than term-born individuals. The aim of this study was to investigate the relationship between cortical and subcortical GM volumes and the course of psychiatric disorders during adolescence in VLBW individuals.

METHODS

We followed VLBW individuals and term-born controls (birth weight ≥10th percentile) from 15 (VLBW;controls n = 40;56) to 19 (n = 44;60) years of age. Of these, 30;37 individuals were examined longitudinally. Cortical and subcortical GM volumes were extracted from MRPRAGE images obtained with the same 1.5 T MRI scanner at both time points and analyzed at each time point with the longitudinal stream of the FreeSurfer software package 5.3.0. All participants underwent clinical interviews and were assessed for psychiatric symptoms and diagnosis (Schedule for Affective Disorders and Schizophrenia for School-age Children, Children's Global Assessment Scale, Attention-Deficit/Hyperactivity Disorder Rating Scale-IV). VLBW adolescents were divided into two groups according to diagnostic status from 15 to 19 years of age: persisting/developing psychiatric diagnosis or healthy/becoming healthy.

RESULTS

Reduction in subcortical GM volume at 15 and 19 years, not including the thalamus, was limited to VLBW adolescents with persisting/developing diagnosis during adolescence, whereas VLBW adolescents in the healthy/becoming healthy group had similar subcortical GM volumes to controls. Moreover, across the entire VLBW group, poorer psychosocial functioning was predicted by smaller subcortical GM volumes at both time points and with reduced GM volume in the thalamus and the parietal and occipital cortex at 15 years. Inattention problems were predicted by smaller GM volumes in the parietal and occipital cortex.

CONCLUSIONS

GM volume reductions in the parietal and occipital cortex as well as smaller thalamic and subcortical GM volumes were associated with the higher rates of psychiatric symptoms found across the entire VLBW group. Significantly smaller subcortical GM volumes in VLBW individuals compared with term-born peers might pose a risk for developing and maintaining psychiatric diagnoses during adolescence. Future research should explore the possible role of reduced cortical and subcortical GM volumes in the pathogenesis of psychiatric illness in VLBW adolescents.

摘要

背景

极低出生体重(VLBW≤1500克)的早产儿面临皮质和皮质下灰质(GM)异常的风险,并且在童年和青少年时期比足月儿有更多的精神问题。本研究的目的是调查极低出生体重个体在青少年时期皮质和皮质下GM体积与精神障碍病程之间的关系。

方法

我们追踪了极低出生体重个体和足月儿对照组(出生体重≥第10百分位数),从15岁(极低出生体重组;对照组n = 40;56)到19岁(n = 44;60)。其中,30名;37名个体接受了纵向检查。在两个时间点,从使用同一台1.5T MRI扫描仪获得的MRPRAGE图像中提取皮质和皮质下GM体积,并使用FreeSurfer软件包5.3.0的纵向流在每个时间点进行分析。所有参与者都接受了临床访谈,并对精神症状和诊断进行了评估(学龄儿童情感障碍和精神分裂症量表、儿童总体评估量表、注意力缺陷/多动障碍评定量表-IV)。极低出生体重青少年根据15至19岁的诊断状况分为两组:持续/发展为精神疾病诊断组或健康/恢复健康组。

结果

15岁和19岁时皮质下GM体积的减少(不包括丘脑)仅限于在青少年时期持续/发展为精神疾病诊断的极低出生体重青少年,而健康/恢复健康组的极低出生体重青少年的皮质下GM体积与对照组相似。此外,在整个极低出生体重组中,两个时间点皮质下GM体积较小以及15岁时丘脑、顶叶和枕叶皮质GM体积减少预示着心理社会功能较差。顶叶和枕叶皮质GM体积较小预示着注意力不集中问题。

结论

顶叶和枕叶皮质GM体积减少以及丘脑和皮质下GM体积较小与整个极低出生体重组中较高的精神症状发生率相关。与足月儿同龄人相比,极低出生体重个体的皮质下GM体积明显较小可能会在青少年时期增加患精神疾病诊断和维持该诊断的风险。未来的研究应探讨皮质和皮质下GM体积减少在极低出生体重青少年精神疾病发病机制中的可能作用。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/2e99/5286868/bf20889961d5/12887_2017_793_Fig1_HTML.jpg

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