【摘要】 目的 探讨孤独症谱系障碍（ASD）儿童经脐血单个核细胞（UCB-MNC）输注治疗前后血氧水平依赖功能性磁共振成像（BOLD-fMRI）的脑功能变化，结合临床评分分析BOLD-fMRI在评估其疗效中的应用价值。方法 收集2021年8月至2022年7月收治的ASD患儿20例，分别在输注UCB-MNC前、输注后6～9个月对ASD儿童行孤独症评定量表（CARS）评定，并对BOLD-fMRI数据进行局部一致性（ReHo）、低频波动振幅（ALFF）分析，比较治疗前后脑功能的变化，经Pearson相关分析ASD患儿治疗后CARS评分与功能变化脑区ReHo、ALFF值的相关性。结果 治疗后，ASD患儿的左中央后回、左舌回、左额中回、右楔叶ReHo值较治疗前增加；左中央后回、左枕中回、ALFF值较治疗前增加（P<0.01）。17例ASD患儿CARS量表提示症状缓解，缓解率为85%;1例治疗后与治疗前CARS评分无变化，2例治疗后CARS评分略有升高。ASD患儿经UCB-MNC治疗后与治疗前相比较，左中央后回、左舌回、右额中回及右楔叶的ReHo差值与CARS评分差值（治疗后-治疗前）呈负相关（r=-0.6340,P=0.0027;r=-0.6678,P=0.0013;r=-0.5768,P=0.0078;r=-0.7565,P=0.0001）；左中央后回和左枕中回的ALFF差值（治疗后-治疗前）与CARS评分差值（治疗后-治疗前）呈负相关(r=-0.8574,P<0.0001;r=-0.5449,P=0.0130）。3例CARS评分未减低儿童治疗后扣带回ReHo值增加，角回ALFF值增加。结论 UCB-MNC治疗后的ASD患儿症状好转。BOLD-fMRI序列可以早期发现ReHo及ALFF改变脑区，提示其在评估UCB-MNC输注对ASD患儿的治疗效果中具有重要价值。更多还原

【Abstract】 Objective To explore the changes in brain function detected by blood oxygen level-dependent functional magnetic resonance imaging(BOLD-fMRI) in children with autism spectrum disorder(ASD) before and after umbilical cord blood mononuclear cell(UCB-MNC) infusion, and to analyze the application value of BOLD-fMRI in evaluating the therapeutic effect by combining with clinical scores. Methods A total of 20 ASD children admitted from August 2021 to July 2022 were enrolled. The Childhood Autism Rating Scale(CARS) was used to assess the children before UCB-MNC infusion and at 6-9 months after infusion. The BOLD-fMRI data were analyzed for regional homogeneity(ReHo) and amplitude of low-frequency fluctuations(ALFF) to compare the changes in brain function before and after treatment. Pearson correlation analysis was performed to explore the correlation between post-treatment CARS scores and ReHo/ALFF values in brain regions with functional changes in ASD children. Results After treatment, the ReHo values in the left postcentral gyrus(L.PoCG), left lingual gyrus(L.LING), left middle frontal gyrus(L. MFG), and right cuneus(R.CUN) of ASD children were significantly higher than those before treatment; the ALFF values in the L.PoCG and left middle occipital gyrus(L.MOG), and right inferior occipital gyrus were also significantly higher than those before treatment(P<0.01). Seventeen children showed symptom relief according to the CARS scale, with a relief rate of 85%; 1 child had no change in CARS score after treatment, and 2 children had a slight increase in CARS score after treatment. Compared with those before treatment, the differences in ReHo(post-treatment minus pre-treatment) in L.PoCG, L.LING, right middle frontal gyrus(R.MFG), and R.CUN of ASD children after UCB-MNC treatment were negatively correlated with the differences in CARS scores(post-treatment minus pretreatment)(r=-0.6340, P=0.0027; r=-0.6678, P=0.0013; r=-0.5768, P=0.0078; r=-0.7565, P=0.0001). The differences in ALFF(post-treatment minus pre-treatment) in the L.PoCG and L.MOG were also negatively correlated with the differences in CARS scores(post-treatment minus pre-treatment)(r=-0.8574, P<0.0001; r=-0.5449, P=0.0130). In 3 children with no reduction in CARS scores, the ReHo value in the cingulate gyrus and the ALFF value in the angular gyrus increased after treatment(P<0.05). Conclusion ASD children showed relieved symptoms after UCB-MNC treatment. The BOLD-fMRI sequence can detect brain regions with changes in ReHo and ALFF at an early stage, which indicates that it has important value in evaluating the therapeutic effect of UCB-MNC infusion in ASD.更多还原