基于低频振荡振幅算法静息态功能MRI研究终末期肾病血液透析患者的脑活动  

Study of brain activity on hemodialysis patients with end-stage renal disease by using resting-state functional MRI with amplitude of low frequency fluctuation algorithm

作　　者：孔祥[1] 季学满[1] 戚荣丰[1] 梁雪[1] 文吉秋 罗松[1] 郭会映[1] 卢光明[1] 张龙江[1] 

机构地区：[1]大学医学院附属金陵医院 南京军区南京总医院医学影像科,南京 210002 [2]大学医学院附属金陵医院全军肾脏病研究所,南京 210002

出　　处：《中华放射学杂志》2014年第10期827-831,共5页Chinese Journal of Radiology

基　　金：国家自然科学基金（81322020,81230032,81171313,81301209）;教育部新世纪优秀人才支持计划（NCET-12-0260）

摘　　要：目的 采用低频振荡振幅（ALFF）算法静息态fMRI（rs-fMRI）研究终末期肾病（ESRD）血液透析（HD）患者脑功能改变特点.方法 对64例ESRD血液透析（HD-ESRD组）患者和45名年龄、性别相匹配的健康志愿者（正常对照组）行rs-fMRI.对所有受试者进行神经心理测试[数字连接试验A（NCT-A）和数字符号试验（DST）]评估其认知功能;检查HD-ESRD组血肌酐、尿素等.采用统计参数图（SPM）8及REST 1.6软件分析2组受试者数据得到ALFF图.对HD-ESRD组和正常对照组ALFF值分别进行组内单样本t检验以及组间两样本t检验,并提取组间差异性脑区ALFF值与神经心理测试结果、病程、透析时程和实验室检查指标进行Pearson相关分析.结果 2组受试者的双侧楔前叶、额上回、额中回、顶下小叶、楔叶和颞上回等脑区ALFF值均高于全脑平均水平.与正常对照组相比,HD-ESRD组的双侧楔前叶、额叶、颞中回及右侧顶下小叶等脑区ALFF值减低（体素体积为270～6 804 mm3,t值为-7.41～-3.78,P值均＜0.01）.HD-ESRD患者右侧额中回ALFF值与DST分值呈正相关（r=0.273,P＜0.05）;左、右楔前叶,左侧缘上回和左侧额内侧回ALFF值与患者肾病病程呈负相关（r值分别为-0.301、-0.278、-0.298和-0.287,P值均＜0.05）;ALFF值与患者的NCT-A值、血肌酐值、尿素值和透析时程无相关性（P值均＞0.05）.结论 HD-ESRD患者存在多个脑区ALFF值的异常,主要位于脑默认网络分布区,提示存在自发脑活动损伤,且与肾病病程有关.Objective To investigate the changes of brain functions in hemodialysis （HD） patients with end-stage renal disease （ESRD） using resting-state functional magnetic resonance imaging （rs-fMRI） with amplitude of low frequency fluctuation （ALFF）algorithm.Methods Sixty-four HD-ESRD patients and forty-five sex and age-matched healthy controls were included in the rs-fMRI study.All subjects were given neuropsychological tests [number connection type-A （NCT-A） and digit symbol test （DST）] to evaluate cognitive function.Laboratory tests,including serum creatinine and urea,were performed in all HD-ESRD patients.SPM8 and REST1.6 software were used to process the data and to generate all subjects＆#39; ALFF maps.One-sample t test was performed to show the spatial pattern of ALFF in each group.Two-sample t test was used to determine the ALFF differences between patients and healthy controls.In addition,Pearson correlation analysis was performed among the ALFF values of significant brain regions and neuropsychological test scores,disease and dialvsis durations,serum creatinine and urea levels.Results Within each group,bilateral precuneus,superior frontal gyrus,middle frontal gyrus,inferior parietal lobule,cuneus and superior temporal gy rus showed higher ALFF values than the global mean ALFF value.Compared with the healthy controls,HD-ESRD patients presented decreased ALFF in bilateral precuneus,frontal lobes,middle temporal gyrus,and right inferior parietal lobule （voxel volumes：270-6 804 mm3,t =-7.41--3.78,all P〈0.01）.The DST scores of HD-ESRD patients positively correlated with ALFF values in right middle frontal gyrus （r=0.273,P〈0.05）.The disease durations negatively correlated with ALFF values in bilateral precuneus,left supramarginal gyrus and left medial frontal gyrus （r =-0.301,-0.278,-0.298,-0.287,allP〈0.05）.The dialysis durations,NCT-A values,serum creatinine and urea levels of HD-ESRD patients showed no significant correlation with ALFF values （all P〉0.05）.Conclusion

关 键 词：肾病 透析 磁共振成像 

分 类 号：R692[医药卫生—泌尿科学] R445.2[医药卫生—外科学]