维持性血液透析患者血清甲状旁腺激素水平与脑血流量及认知功能的相关性

目的 评价维持性血液透析（MHD）患者甲状旁腺激素（PTH）与脑血流量（CBF）、认知功能的相关性。方法 纳入53例MHD患者，根据血清PTH水平分为高PTH组（n=21）和低PTH组（n=32）；招募同期25名健康志愿者作为对照组。采用MR三维动脉自旋标记（3D-ASL）技术检测3组全脑、脑灰质及脑白质CBF；以简易精神状态检查（MMSE）和蒙特利尔认知评估（MoCA）评价受试者认知功能。比较组间CBF及认知评分差异，采用偏相关分析评价PTH与CBF、MMSE及MoCA评分的相关性。结果 低PTH组全脑、脑灰质及脑白质CBF较对照组显著升高（P均<0.05），高PTH组CBF与对照组差异均无统计学意义（P均>0.05）。高PTH组、低PTH组MMSE、MoCA评分均明显低于对照组（P均<0.05），且高PTH组评分明显低于低PTH组（P均<0.05）。PTH与全脑、脑灰质及脑白质CBF均呈负相关（r=-0.320、-0.322、-0.312，P均<0.05），PTH与MMSE、MoCA评分均呈负相关（r=-0.280、-0.312，P均<0.05）。结论 MHD患者PTH水平与CBF及认知功能呈负相关。

Correlation of serum parathyroid hormone and cerebral blood flow, cognitive function in maintenance hemodialysis patients

Objective To observe the correlation of parathyroid hormone (PTH) and cerebral blood flow (CBF), cognitive function in maintenance hemodialysis (MHD) patients. Methods A total of 53 MHD patients were enrolled and divided into high PTH group (n=21) and low PTH group (n=32) according to serum PTH level. Totally 25 healthy volunteers were recruited as controls. CBF of whole brain, gray matter and white matter of 3 groups were measured with MR three-dimensional arterial spin labeling (3D-ASL). Cognitive function was evaluated with mini-mental state examination (MMSE) and Montreal cognitive assessment (MoCA) scale. CBF and cognitive scores were compared among groups. Partial correlation analysis was used to evaluate the correlation of PTH and CBF, MMSE and MoCA scores. Results CBF of whole brain, gray matter and white matter in low PTH group were all significantly higher than those in control group (all P<0.05), while CBF in high PTH group were not significantly different from those in control group (all P>0.05). The scores of MMSE and MoCA in high PTH group and low PTH group were significantly lower than those in control group (all P<0.05), and in high PTH group were significantly lower than those in low PTH group (both P<0.05). PTH was negatively correlated with CBF of whole brain, gray matter and white matter (r=-0.320, -0.322, -0.312, all P<0.05), also negatively correlated with MMSE and MoCA scores (r=-0.280, -0.312, both P<0.05). Conclusion The level of PTH was negatively correlated with CBF and cognitive function in MHD patients.