Data Sheet 1_Glymphatic system dysfunction in children with autism spectrum disorder as evidenced by the diffusion tensor imaging along perivascular spaces index.docx

IntroductionThis study aims to evaluate glymphatic system function in autism spectrum disorder (ASD) by employing diffusion tensor imaging along perivascular spaces (DTI-ALPS), and investigate its relationship with visual-motor integration (VMI) function.
Materials and methodsA total of 78 individuals with ASD and 48 typically developing (TD) children were enrolled. All participants underwent diffusion tensor imaging on a 3-T MRI scanner. The DTI-ALPS index was calculated, and data on IQ and VMI function were obtained. Independent-samples t-test was used to compare the DTI-ALPS index between groups. Correlation analysis was conducted to examine the relationships between the DTI-ALPS index and clinical variables, including core symptoms, within the ASD group. Mediation analysis explored the relationship among the DTI-ALPS index, core symptoms, and VMI function.
ResultsCompared to the TD group, ASD patients showed significantly reduced DTI-ALPS indices in the left hemisphere (DTI-ALPS-L), right hemisphere (DTI-ALPS-R), and for the whole-brain mean (Mean DTI-ALPS). In the ASD group, these indices were negatively correlated with the Autism Diagnostic Interview-Revised (ADI_R) communication score but positively correlated to the VMI score. Mediation analysis revealed that the VMI score significantly mediated the relationship between DTI-ALPS-R and the ADI_R communication score (indirect effect β = -0.082, p< 0.001).
ConclusionsOur preliminary findings indicate impaired glymphatic system function in ASD, which may contribute to its pathogenesis. Furthermore, VMI function mediates the relationship between altered glymphatic system function and communication deficits in ASD.

引言
本研究旨在通过沿血管周围间隙扩散张量成像（diffusion tensor imaging along perivascular spaces, DTI-ALPS）评估孤独症谱系障碍（autism spectrum disorder, ASD）患者的胶质淋巴系统功能，并探讨其与视动整合（visual-motor integration, VMI）功能的关联。

材料与方法
本研究共纳入78名ASD患者与48名典型发育（typically developing, TD）儿童。所有受试者均接受3特斯拉磁共振成像扫描仪的扩散张量成像扫描。计算DTI-ALPS指数，并收集智商（IQ）与VMI功能相关数据。采用独立样本t检验比较两组间的DTI-ALPS指数差异；在ASD组内开展相关分析，以探讨DTI-ALPS指数与包括核心症状在内的临床变量之间的关联；通过中介分析探究DTI-ALPS指数、核心症状与VMI功能三者间的关系。

结果
与TD组相比，ASD患者的左侧半球DTI-ALPS指数（DTI-ALPS-L）、右侧半球DTI-ALPS指数（DTI-ALPS-R）及全脑平均DTI-ALPS指数（Mean DTI-ALPS）均显著降低。在ASD组内，上述指数与孤独症诊断访谈量表修订版（Autism Diagnostic Interview-Revised, ADI-R）的沟通得分呈负相关，而与VMI得分呈正相关。中介分析结果显示，VMI得分在DTI-ALPS-R与ADI-R沟通得分之间发挥显著中介效应（间接效应β=-0.082，p<0.001）。

结论
本研究的初步结果表明，ASD患者的胶质淋巴系统功能受损，这可能参与了ASD的发病机制。此外，VMI功能在胶质淋巴系统功能异常与ASD沟通障碍之间发挥中介作用。