终末期肾病患者大脑自发神经活动异常的静息态MR成像

目的采用基于静息态功能MRI(rs-fMRI)的低频振幅算法(ALFF)探讨终末期肾病(ESRD)患者大脑自发神经活动异常改变。方法纳入40例ESRD患者(男23例,女17例)及年龄、性别和教育年限相匹配的40例正常对照(HC)(男23例,女17例),采用神经心理学量表评估被试的认知功能并采集rs-fMRI数据。图像预处理后比较组间ALFF值的差异;提取ESRD组差异脑区的平均ALFF值与临床资料及神经认知量表进行相关性分析。结果ESRD患者存在多维度认知功能损害(P<0.01)。与HC相比,ESRD患者双侧楔前叶、左中央后回及左颞极:颞上回ALFF值显著降低,双侧小脑8区ALFF值显著升高(P<0.05,FWE校正)。双侧楔前叶平均ALFF值与红细胞(r=0.477,P=0.002;r=0.508,P=0.009)、血红蛋白(r=0.516,P<0.001;r=0.469,P=0.002)及红细胞比容(r=0.557,P<0.001;r=0.471,P=0.002)水平呈正相关。控制本实验涉及的所有临床变量后,发现右小脑8区与TMTA(r=0.597,P=0.003)及TMTB(r=0.555,P=0.007)呈正相关;左中央后回与FDST呈正相关(r=0.552,P=0.008)。结论ESRD患者整体认知功能受损;ESRD患者存在双侧楔前叶、左中央后回及左颞极:颞上回等参与认知活动脑区的自发脑活动受损;贫血可能影响ESRD患者大脑自发神经活动。

Functional MRI of spontaneous brain activity in patients with end-stage renal disease

Objective To explore the changes of spontaneous brain activity in patients with end-stage renal disease(ESRD)using amplitude of low-frequency fluctuation(ALFF)algorithm in resting state functional MRI(rs-fMRI).Methods Forty patients with ESRD(23 men,17 women)and 40 matched healthy controls matched in age,gender and years of education(23 men,17 women)were enrolled.Neuropsychology scales were used to estimate the cognitive function.Clinical and rs-fMRI data were acquired in all subjects.After rs-fMRI data preprocessing,the difference of ALFF between the two groups was analyzed.The mean ALFF values of significant brain regions were extracted and correlation analysis among the mean ALFF values,clinical data and neuropsychology scales was performed in patients with ESRD.Results Compared with healthy control,ESRD patients had multidimensional cognitive impairment(P<0.01),significantly decreased ALFF values in the bilateral precuneus,left postcentral gyrus and left superior temporal gyrus,and increased ALFF values in the bilateral cerebellum lobulesⅧ(P<0.05,FWE corrected).There were positive correlations between the mean ALFF values of the bilateral precuneus and red blood cell(r=0.477,P=0.002;r=0.508,P=0.009),hemoglobin(r=0.516,P<0.001;r=0.469,P=0.002)and hematocrit(r=0.557,P<0.001;r=0.471,P=0.002)levels.After controlling all clinical variables involved in this experiment,positive correlations were found between the mean ALFF value of the right cerebellum lobuleⅧand TMTA(r=0.597,P=0.003)and TMTB(r=0.555,P=0.007);between the left postcentral gyrus and FDST(r=0.552,P=0.008).Conclusion ESRD patients have overall cognitive decline with impaired spontaneous brain activity in the bilateral precuneus,left postcentral gyrus and left superior temporal gyrus.Anemia may affect spontaneous brain activity in ESRD patients.