基于局部弥散一致性值观察终末期肾病继发性甲状旁腺功能亢进症患者脑白质改变及认知相关性  

Brain white matter changes and correlations with cognition in end-stage renal disease patients with secondary hyperparathyroidism based on local diffusion homogeneity values

作　　者：吴旱秋 单艳棋 邹立巍[1] 张莹 刘桂凌[3] 张晶晶[3] 吴文杰 王龙胜[1,2] WU Hanqiu;SHAN Yanqi;ZOU Liwei;ZHANG Ying;LIU Guiling;ZHANG Jingjing;WU Wenjie;WANG Longsheng(Department of Radiology,the Second Hospital of Anhui Medical University,Hefei 230601,China;Image Center,Anhui Medical University,Hefei 230032,China;Division of Nephrology,the Second Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽合肥230601 [2]安徽医科大学医学影像研究中心,安徽合肥230032 [3]安徽医科大学第二附属医院肾内科,安徽合肥230601

出　　处：《中国医学影像技术》2020年第1期37-41,共5页Chinese Journal of Medical Imaging Technology

摘　　要：目的采用局部弥散一致性(LDH)探讨终末期肾病(ESRD)继发甲状旁腺功能亢进症(SHPT)患者脑白质改变。方法选取50例接受血液透析的ESRD患者,根据是否伴有SHPT分为SHPT组(25例)与非SHPT组(25例),利用蒙特利尔认知评估(MoCA)量表评估认知功能,并进行MR平扫及DTI数据采集,对全脑白质纤维LDH值进行基于体素的组间比较。结果相比非SHPT组,SHPT组出现双侧大脑半球弥漫性、对称分布的LDH减低区及右侧小脑半球局灶性LDH减低区(P均<0.01),LDH值升高区域集中在脑干及小脑(P均<0.01)。SHPT组MoCA总评分与全段甲状旁腺激素(iPTH)水平呈负相关(r=-0.525),与受教育水平呈正相关(r=0.413)、与左侧皮质脊髓束的LDH值呈正相关(r=0.500,P均<0.05);iPTH水平与差异脑区的LDH值均无明显相关(P均>0.05)。结论LDH值可提供ESRD伴SHPT患者脑白质LDH信息:脑白质LDH改变与认知及临床指标具有相关性。Objective To investigate the changes of white matter in patients of end-stage renal disease(ESRD)with secondary hyperparathyroidism(SHPT)by using local diffusion homogeneity(LDH).Methods Fifty patients diagnosed as ESRD and underwent hemodialysis were selected.According to whether with SHPT or not,the patients were divided into SHPT group and non-SHPT group(each n=25).The cognitive function was evaluated with Montreal cognitive assessment(MoCA).Then MR plain scan was performed.The LDH value of white matter fiber in the whole brain were compared between 2 groups based on voxel.Results Compared with non-SHPT group,SHPT group showed diffuse and symmetrical LDH decreased area in bilateral cerebral hemispheres,and in the focal right cerebellar hemispheres(all P<0.01).The areas with increased LDH value were mainly in brainstem and cerebellum(P<0.01).In SHPT group,the total score of MoCA was negatively correlated with the level of iPTH(r=-0.525),positively correlated with the level of education(r=0.413).The total score of MoCA was positively correlated with LDH value of left corticospinal tract(r=0.500,all P<0.05),while the level of iPTH was not correlated with the LDH value of different brain regions in SHPT group(all P>0.05).Conclusion LDH value can provide information of the white matter's LDH in ESRD patients with SHPT,and the changes are related to cognition and clinical indicators.

关 键 词：肾衰竭 慢性 甲状旁腺功能亢进症 继发性 认知 

分 类 号：R582.1[医药卫生—内分泌] R445.2[医药卫生—内科学]