基于表面的形态学分析对终末期肾病患者透析开始前大脑皮层厚度研究  

Morphological study of ESRD patients before hemodialysis initiation based on SBM analysis

作　　者：丁墩 马雪英[2] 李朋[2] 张盼[1] 麻少辉[2] 张燕[3] 张明[2] DING Dun;MA Xueying;LI Peng;ZHANG Pan;MA Shaohui;ZHANG Yan;ZHANG Ming(Department of Diagnostic Radiology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004;Department of Radiology,The First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061;Department of Radiology,Baoji Hospital of Traditional Chinese Medicine,Baoji 721000,China)

机构地区：[1]西安交通大学第二附属医院医学影像科,陕西西安710004 [2]西安交通大学第一附属医院医学影像科,陕西西安710061 [3]宝鸡市中医医院影像科,陕西宝鸡721000

出　　处：《西安交通大学学报（医学版）》2020年第2期167-171,共5页Journal of Xi’an Jiaotong University（Medical Sciences）

基　　金：陕西省自然科学基础研究计划重大基础研究项目(No.S2017-ZRJJ-ZDXM-0058);西安交通大学第一附属医院临床研究课题重点项目(No.XJTU1AF-CRF-2018-006);宝鸡市科技计划项目(16SFGG3-5)~~

摘　　要：目的探寻终末期肾病(end-stage renal disease,ESRD)患者脑认知功能异常相关的灰质皮层微结构改变及其临床相关危险因素。方法对34例血液透析开始前的ESRD患者(患者组)和34例健康志愿者(对照组)进行高分辨3D T1结构成像,利用基于表面的形态学(surface based morphology,SBM)分析方法检测2组的大脑灰质皮层厚度差异,在回归性别、年龄及受教育程度后,对患者组的SBM分析结果进行临床行为认知量表评分及血清学实验室检查指标的Pearson相关分析。结果与对照组比较,患者组在透析治疗前就已经出现了广泛的大脑皮层厚度减低(P<0.01,FDR校正),主要包括双侧中央后回、双侧中央前回、双侧顶下小叶、双侧楔前叶以及部分额叶、颞叶区域。相关分析结果显示,患者组血尿酸水平与右侧楔前叶的皮层厚度呈负相关(r=-0.543,P<0.01),AVL-IR评分与双侧顶下小叶皮层厚度呈正相关(右侧r=0.522,左侧r=0.649,P均<0.01)。结论ESRD患者首次透析前就存在广泛皮层厚度减低,且与整体认知、瞬时记忆功能下降有关;高的血尿酸浓度是首次透析前ESRD患者皮层形态学改变的主要相关因素。Objective To explore the potential clinical risk factors related to abnormal microstructure of brain gray matter in end-stage renal disease(ESRD)patients with cognitive dysfunction.Methods 3D high-resolution structural imaging was applied in 34 ESRD patients before hemodialysis and 34 health controls.We analyzed the characteristics of changes in gray matter cortical thickness in patients with ESRD before the first dialysis by surface based morphology(SBM)analysis.Further P earson correlation analysis was used to reveal the relationship of the changed cortical thickness with the laboratory test indicators and clinical scale scores in patient group,with the covariants of age,sex and education removed.Results Compared with that in control group,the broad cortex thickness decreases were observed in patients with ESRD before the first dialysis(P<0.01,FDR corrected),mainly including the bilateral postcentral gyrus,bilateral precentral gyrus,bilateral inferior parietal lobe(IPL),bilateral precuneus and some frontal and temporal lobes.P earson correlation analysis showed that the cortical thickness in the IPL and precuneus had significantly negative correlation with uric acid level(r=-0.543,P<0.01)and the decreased thickness of bilateral IPL was positively related to AVL-IR score(right r=0.522,left r=0.649,P<0.01).Conclusion ESRD patients showed extensive cortical thickness reduction before dialysis initiation,which corrected with overall cognition and immediate memory dysfunction.High uric acid level was the major factor of morphlolgical changes in ESRD patients before dialysis initiation.

关 键 词：终末期肾病 磁共振成像 皮层厚度 认知功能 

分 类 号：R445.2[医药卫生—影像医学与核医学]